A laboratory algorithm with homocysteine as the primary parameter reduces the cost of investigation of folate and cobalamin deficiency

Schedvin, Göran
Jones, Ian
Hultdin, Johan
Nilsson, Torbjörn K.

¹University Hospital, Department of Clinical Chemistry, Örebro, Sweden
²University Hospital, Medical Biosciences, Clinical Chemistry, Umeå, Sweden

^*Corresponding author: Göran Schedvin, MD, University Hospital, Department Clinical Chemistry, 701 85 Örebro, Sweden. Phone: + 46-19-6027819, Fax: + 46-19-6023785, E-mail: [email protected]

Clinical Chemistry and Laboratory Medicine 43(10):p 1065-1068, October 2005.

Analyses of total homocysteine (tHcy) and to some extent methyl malonic acid (MMA) have become increasingly used in Sweden, primarily for investigating folate and cobalamin deficiency. This has led to increasing costs for diagnosis and laboratory testing, since clinicians still order the established tests, cobalamin and folate. The purpose of this study was to compare the profile of test parameters in six Swedish counties, using laboratory statistics from 2003, and to relate these to medical prescriptions for folate and cobalamin in the same counties. We also wanted to evaluate whether or not a laboratory algorithm with tHcy as the primary test-parameter, followed by vitamin analyses only when tHcy is above a certain decision limit, could reduce the expanding cost of diagnosing folate and cobalamin deficiency. For this analysis we used patient results from two counties in Sweden collected during 2003. There is a slight positive correlation between resources spent upon tests and resources spent upon treating these deficiencies, and a laboratory algorithm based upon initial analysis of tHcy, instead of conventional clinical requests for all parameters, could save approximately 30% of laboratory costs. Atypical annual saving in one of these counties (ca. 260,000 inhabitants) by implementing this algorithm would be ca €100,000.