title: Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting.
abstract: OBJECTIVE
  To study the regional variability of requests for anaemia chemistry tests in primary care in Spain and the associated economic costs of potential over-requesting.
  
  
  METHODS
  Requests for anaemia tests were examined in a cross-sectional study. Clinical laboratories from different autonomous communities (AACCs) were invited to report on primary care anaemia chemistry tests requested during 2014. Demand for iron, ferritin, vitamin B12 and folate tests per 1000 inhabitants and the ratios of the folate/vitamin B12 and transferrin/ferritin requests were compared between AACCs. We also calculated reagent costs and the number of iron, transferrin and folate tests and the economic saving if every AACC had obtained the results achieved by the AACC with best practice.
  
  
  RESULTS
  110 laboratories participated (59.8% of the Spanish population). More than 12 million tests were requested, resulting in reagent costs exceeding €16.5 million. The serum iron test was the most often requested, and the ferritin test was the most costly (over €7 million). Close to €4.5 million could potentially have been saved if iron, transferrin and folate had been appropriately requested (€6 million when extrapolated to the whole Spanish population).
  
  
  CONCLUSIONS
  The demand for and expenditure on anaemia chemistry tests in primary care in Spain is high, with significant regional differences between different AACCs.
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.|Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernández, Elche, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Salinas
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: López-Garrigós
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.|Department of Clinical Medicine, Universidad Miguel Hernández, Elche, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Flores
authors.affiliation: Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
mesh_terms: D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000191:economics; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000191:economics / Q000639:trends*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005293:Ferritins / Q000097:blood; D005492:Folic Acid / Q000097:blood*; D017048:Health Care Costs / Q000639:trends; D006301:Health Services Needs and Demand / Q000191:economics; D006302:Health Services Research; D054625:Healthcare Disparities / Q000191:economics / Q000639:trends*; D006801:Humans; D007501:Iron / Q000097:blood*; D000069342:Medical Overuse / Q000191:economics / Q000639:trends*; D020380:Needs Assessment / Q000639:trends; D058007:Physicians, Primary Care / Q000191:economics / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000191:economics / Q000639:trends*; D013030:Spain; D014168:Transferrin / Q000032:analysis*; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D015415:Biomarkers; D014168:Transferrin; D005293:Ferritins; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12
keywords: B12; IRON METABOLISM; LABORATORY TESTS; PERNICIOUS ANAEMIA