Custos de exames em um laboratório clínico hospitalar no Chile

Estudo retrospectivo com informações de julho de 2014 a junho de 2015. Foram selecionados 92 exames classificados em dez grupos de acordo com a metodologia de análise. Os custos foram estimados como a soma dos custos diretos e indiretos de laboratório e fatores institucionais indiretos.

Resultados:

Os valores médios dos custos foram obtidos de acordo com o grupo de exames (em dólares): 1,79 (química clínica), 10,21 (técnicas de imunoensaio), 13,27 (coagulação), 26,06 (cromatografia líquida de alta resolução), 21,2 (imunológicos), 3,85 (gases e eletrólitos), 156,48 (citogenéticos), 1,38 (urina), 4,02 (hematológicos automáticos), 4,93 (hematológicos manuais).

Conclusão:

O valor retornado às instituições públicas, ou taxas de serviço, que prestam serviços laboratoriais não refletem adequadamente os custos totais reais da produção de exames.

Descritores:
Custos Médios; Diagnósticos e Exames Laboratoriais; Custos Diretos e Indiretos; Tarifa de Serviço; Produção de Exames

Group and exam description	Average direct laboratory costs (ADLC)			Sub-total ADLC	Sub-total Average Indirect Laboratory and Indirect Institutional Costs		Total Average Cost(TAC)
Group and exam description	Reagents	Internal and external controls	Direct labor	Sub-total ADLC	AILC	AIIC	Total Average Cost(TAC)
Clinical chemistry ( G1)
Uric acid	0.27	0.03	0.50	0.81	0.25	0.08	1.13
Albumin	0.24	0.01	0.50	0.74	0.25	0.08	1.07
Amikacin plasma levels	3.46	0.03	0.50	3.99	0.25	0.08	4.32
Amylase	0.50	0.01	0.50	1.01	0.25	0.08	1.33
Ammonium	3.81	0.00	0.50	4.31	0.25	0.08	4.64
Unconjugated bilirubin (BuBc)	0.24	0.01	0.50	0.75	0.25	0.08	1.07
Total bilirubin	0.25	0.01	0.50	0.76	0.25	0.08	1.08
C3	2.72	0.03	0.50	3.24	0.25	0.08	3.57
C4	2.74	0.03	0.50	3.27	0.25	0.08	3.59
Calcium	0.24	0.03	0.50	0.77	0.25	0.08	1.10
CK	0.50	0.01	0.50	1.00	0.25	0.08	1.33
CK MB	0.58	0.01	0.50	1.09	0.25	0.08	1.41
Cholesterol	0.22	0.01	0.50	0.73	0.25	0.08	1.05
Creatinine	0.24	0.03	0.50	0.77	0.25	0.08	1.10
Rheumatoid factor	3.18	0.00	0.50	3.69	0.25	0.08	4.01
Alkaline Phosphatase	0.25	0.01	0.50	0.75	0.25	0.08	1.08
Phosphorus	0.25	0.03	0.50	0.78	0.25	0.08	1.10
GGT	0.38	0.01	0.50	0.88	0.25	0.08	1.21
Glucose	0.21	0.03	0.50	0.75	0.25	0.08	1.07
GOT/AST	0.25	0.01	0.50	0.76	0.25	0.08	1.09
GPT / ALT	0.24	0.01	0.50	0.75	0.25	0.08	1.08
HDL	1.14	0.01	0.50	1.64	0.25	0.08	1.97
IgA	2.61	0.01	0.50	3.12	0.25	0.08	3.45
IgG	2.63	0.01	0.50	3.13	0.25	0.08	3.46
IgM	2.03	0.01	0.50	2.54	0.25	0.08	2.87
Lactate	0.52	0.01	0.50	1.03	0.25	0.08	1.36
LDH	0.25	0.01	0.50	0.76	0.25	0.08	1.09
Lipase	0.76	0.01	0.50	1.27	0.25	0.08	1.60
Magnesium	0.25	0.01	0.50	0.76	0.25	0.08	1.09
Blood urea nitrogen (BUN)	0.24	0.03	0.50	0.77	0.25	0.08	1.09
C-reactive protein	0.83	0.00	0.50	1.33	0.25	0.08	1.66
LCR Protein	0.43	0.00	0.50	0.93	0.25	0.08	1.25
Total protein	0.24	0.01	0.50	0.75	0.25	0.08	1.07
Urine Protein	0.28	0.02	0.50	0.80	0.25	0.08	1.13
Triglycerides	0.22	0.01	0.50	0.73	0.25	0.08	1.05

Group and exam description	Average direct laboratory costs (ADLC)			Sub-total ADLC	Sub-total Average Indirect Laboratory and Indirect Institutional Costs		TotalAverage Cost(TAC)
Group and exam description	Reagents	Internal and external controls	Direct labor	Sub-total ADLC	AILC	AIIC	TotalAverage Cost(TAC)
Immunoassays (G2)
25-Hydroxy Vitamin D	20.64	0.03	0.50	21.17	0.85	0.08	22.09
Alpha-fetoprotein	6.64	0.71	0.50	7.84	0.85	0.08	8.77
aTG	8.90	0.00	0.50	9.40	0.85	0.08	10.32
aTPO	8.47	0.00	0.50	8.97	0.85	0.08	9.90
Immunoassays (G2)
Cyclosporine Plasma Level	16.84	0.15	0.50	17.49	0.85	0.08	18.41
Cortisol	6.26	0.03	0.50	6.79	0.85	0.08	7.72
Ferritin	5.41	0.03	0.50	5.95	0.85	0.08	6.87
Chorionic gonadotropin	7.50	0.03	0.50	8.03	0.85	0.08	8.96
Insulin	4.83	0.03	0.50	5.36	0.85	0.08	6.29
Methotrexate Plasma Level	11.74	0.00	0.50	12.24	0.85	0.08	13.17
PTH	11.66	0.00	0.50	12.16	0.85	0.08	13.09
T4	2.69	0.05	0.50	3.24	0.85	0.08	4.16
Free T4	2.23	0.04	0.50	2.77	0.85	0.08	3.69
Tacrolimus Plasma Level	16.70	0.15	0.50	17.34	0.85	0.08	18.26
TSH	2.47	0.05	0.50	3.01	0.85	0.08	3.94
Vancomycin Plasma Level	6.26	0.03	0.50	6.79	0.85	0.08	7.71
Coagulation (G3)
Lupus Anticoagulant	18.21	0.00	1.16	19.37	0.31	0.12	19.81
Anti-Factor X	15.20	0.00	1.16	16.36	0.31	0.12	16.79
Antithrombin III	20.42	0.05	1.16	21.64	0.31	0.12	22.07
Factor IX	15.23	0.00	1.16	16.39	0.31	0.12	16.82
Factor VII	15.23	0.00	1.16	16.39	0.31	0.12	16.82
Factor VIII	15.23	0.00	1.16	16.39	0.31	0.12	16.82
Fibrinogen	3.07	0.05	1.16	4.28	0.31	0.12	4.71
TP	1.07	0.07	1.16	2.30	0.31	0.12	2.73
TTPA	1.16	0.07	1.16	2.39	0.31	0.12	2.82

Group and exam description	Average direct laboratory costs (ADLC)			Sub-total ADLC	Sub-total Average Indirect Laboratory and Indirect Institutional Costs		TotalAverage Cost(TAC)
Group and exam description	Reagents	Internal and external controls	Direct labor	Sub-total ADLC	AILC	AIIC	TotalAverage Cost(TAC)
HPLC ( G4 )
Mycophenolic Ac. plasma level	3.26	1.47	0.50	5.23	19.22	0.08	24.53
Voriconazole plasma level	7.07	0.00	0.50	7.57	19.22	0.08	26.87
Posaconazole plasma level	6.98	0.00	0.50	7.48	19.22	0.08	26.78
Immunology (G5)
Antitransglutaminase AB IgA	9.82	0.15	5.33	15.30	1.86	0.56	17.72
Anti-DNA AB (aDNA)	7.52	0.14	5.33	12.99	1.86	0.56	15.42
Antibody to Extractable Nuclear Antigen (aENA) profile (identification)	16.40	0.86	5.33	22.59	1.86	0.56	25.02
Anti-cardiolipin AB identification (IgG or IgA)	18.37	0.00	5.33	23.70	1.86	0.56	26.12
Antineutrophil cytoplasmic AB (cANCA)	22.15	0.00	5.33	27.48	1.86	0.56	29.91
Antinuclear AB (ANA)	9.17	0.14	5.33	14.64	1.86	0.56	17.06
Mitochondrial AB and anti-smooth muscle AB.	15.32	0.00	5.33	20.65	1.86	0.56	23.07
Antiendomysial AB	7.54	0.00	5.33	12.87	1.86	0.56	15.29
Gases and electrolytes (G6)
Arterial blood gases/+ plasma electrolytes	1.17	0.01	0.50	1.68	0.55	0.08	2.30
Urinary electrolytes	1.07	0.00	0.50	1.57	3.75	0.08	5.39

Group and exam description	Average direct laboratory costs (ADLC)			Sub-total ADLC	Sub-total Average Indirect Laboratory and Indirect Institutional Costs		TotalAverage Cost(TAC)
Group and exam description	Reagents	Internal and external controls	Direct labor	Sub-total ADLC	AILC	AIIC	TotalAverage Cost(TAC)
Cytogenetics (G7)
Karyogram blood test with lymphocyte culture	5.55	0.67	107.79	114.01	9.69	4.38	128.09
Karyogram with special techniques	11.62	0.67	107.79	120.09	9.69	4.38	134.16
Karyogram in fibroblast with tissue culture	33.74	0.67	107.79	142.20	9.69	4.38	156.28
FISH	85.55	0.00	107.79	193.34	9.69	4.38	207.41
Urine (G8)
Full urine	0.50	0.02	0.50	1.03	0.28	0.08	1.38
Automated hematology (G9)
Blood picture + Reticulocytes	1.07	1.09	1.16	3.32	0.58	0.12	4.02
Hematology by manual techniques (G10)
Hemogram	1.15	0.00	1.16	2.31	0.23	0.12	2.66
Reticulocyte count	0.24	0.00	1.16	1.40	0.23	0.12	1.75
Osmotic fragility	0.76	0.00	1.16	1.92	0.23	0.12	2.27
Glucose-6-phosphate dehydrogenase	4.25	0.00	1.16	5.41	0.23	0.12	5.76
Sickle cells (Drepanocytes)	1.18	0.00	1.16	2.34	0.23	0.12	2.69
Peroxidases	0.92	0.00	1.16	2.08	0.23	0.12	2.44
PAS (Periodic acid-Schiff)	2.82	0.00	1.16	3.98	0.23	0.12	4.34
Esterases	9.65	0.00	1.16	10.81	0.23	0.12	11.16
Fetal hemoglobin	0.91	0.00	1.16	2.07	0.23	0.12	2.43
HAM test	3.15	0.00	1.16	4.31	0.23	0.12	4.67
LCR cytology	1.11	0.00	1.16	2.27	0.23	0.12	2.63
Hemoglobin electrophoresis	17.62	0.00	1.16	18.78	0.23	0.12	19.13
VHS	0.59	0.02	1.16	1.77	0.25	0.12	2.14

Exam description	FONASA IAM fee and TAC (USD)		Profitability (%)	Annual production of examinations (number)	TC of examinations (USD)	IT from examinations performed
	IAM	TAC	MAI - CMT	n	TC = n x TAC	TI = n x IAM
	IAM	TAC	MAI	n	TC = n x TAC	TI = n x IAM
Uric acid	1.86	1.13	39.21	2,711	3,068	5,047
Albumin	1.71	1.07	37.32	18,508	19,810	31,606
Amikacin plasma level	6.62	4.32	34.76	791	3,414	5,233
Amylase	2.74	1.33	51.37	2,025	2,697	5,545
Ammonium	2.48	4.64	-87.37	1,241	5,759	3,074
Total bilirubin	1.54	1.08	29.52	32,247	34,966	49,611
C3	5.40	3.57	33.96	350	1,248	1,890
C4	5.40	3.59	33.49	350	1,257	1,890
Calcium	1.35	1.10	19.06	18,980	20,798	25,696
CK	4.25	1.33	68.67	815	1,084	3,461
CK MB	5.55	1.41	74.54	405	573	2,249
Cholesterol	1.62	1.05	34.92	19,573	20,578	31,618
Creatinine	1.57	1.10	29.99	24,900	27,354	39,074
Rheumatoid factor	5.57	4.01	27.96	150	602	835
Alkaline Phosphatase	1.58	1.08	31.88	18,175	19,617	28,800
Phosphorus	2.05	1.10	46.03	18,802	20,763	38,472
GGT	2.63	1.21	54.04	7,022	8,490	18,473
Glucose	1.57	1.07	31.72	19,944	21,369	31,297
Insulin	6.14	6.29	-2.39	600	3,771	3,683
Methotrexate Plasma Level	6.62	13.17	-99.01	1,000	13,165	6,615
T4	5.37	4.16	22.46	1,000	4,163	5,369
Free T4	6.14	3.69	39.90	1,700	6,272	10,435
TSH	5.37	3.94	26.64	2,500	9,847	13,423
Vancomycin Plasma Level	6.62	7.71	-16.57	1,800	13,881	11,908
Fibrinogen	2.48	4.71	-90.24	1,048	4,938	2,596
TP	2.12	2.73	-28.54	5,756	15,708	12,220
TTPA	2.71	2.82	-4.14	4,668	13,163	12,640
Karyogram blood test with lymphocyte culture	54.11	128.09	-136.73	500	64,044	27,054
Karyogram with special techniques	57.86	134.16	-131.86	351	47,090	20,309
Karyogram in fibroblast with tissue culture	57.86	156.28	-170.09	55	8,595	3,182
Full urine	2.22	1.38	37.49	12,100	16,757	26,806
Hemogram (includes VHS)	3.55	4.81	-35.29	36,000	173,094	127,938
Totals				256,067	607,936	608,050

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[1] CORRESPONDING AUTHOR: Carolina Salas Palma. E-mail: csalas@calvomackenna.cl