Abstract:
BACKGROUND : Countries across the globe report an increase in expenditure associated with
medical laboratory testing. In 2020, the United States Department of Health and Human
Services reported that laboratory test expenditures increased by $459 million US dollars (USD)
from $7.1 billion USD in 2018. In South Africa, laboratory testing expenditure in the public
sector increased from $415 million USD in 2014 to $723 million USD in 2021.
OBJECTIVE : This study aimed to evaluate the impact of an innovative software, electronic
gatekeeping (EGK), on medical laboratory test expenditures at Nelson Mandela Academic
Hospital, in the Eastern Cape, South Africa.
METHODS : In this cross-sectional study, an interrupted time series analysis technique was used
to evaluate trends in expenditure during a 48-month study period. To measure the impact of
EGK on laboratory expenditure, we analysed laboratory expenditure over two study periods:
a period of 24 months occurring before EGK implementation (01 June 2013 to 31 May 2015) and
a period of 24 months occurring during EGK implementation (01 June 2015 to 30 May 2017).
RESULTS : There was a significant reduction (211 928 fewer tests) in the number of tests performed
during the intervention (434 790) compared to before the intervention (646 718). Laboratory
test expenditure was $1 663 756.72 USD before the intervention period and $1 105 036.88 USD
during the intervention period, demonstrating a cost savings of $558 719.84 USD.
CONCLUSION : Electronic gatekeeping is a cost-effective intervention for managing medical
laboratory expenditures. We recommend that the health sector scale up this intervention
nationally.
WHAT THIS STUDY ADDS : Using an interrupted time series interval, the authors determined that
EGK is a cost-effective intervention for managing medical laboratory expenditures at a tertiary
hospital. This study’s findings can promote and contribute to improved laboratory systems
and test investigations.