Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management

• Cost of urine drug testing for medication compliance in pain management was high.
• We describe transferring testing from a reference lab into our clinical laboratory.
• We in-sourced testing in 27 months and saved approximately $1 million.
• Budgeting adequate resources and developing a realistic timeline was critical.

IntroductionReference laboratory testing can represent a significant component of the laboratory budget. Therefore, most laboratories continually reassess the feasibility of in-sourcing various tests. We describe the transfer of urine drug testing performed for monitoring medication compliance in pain management from a reference laboratory into an academic clinical laboratory.MethodsThe process of implementing of both screening immunoassays and confirmatory LC–MS/MS testing and the associated cost savings is outlined.ResultsThe initial proposal for in-sourcing this testing, which included the tests to be in-sourced, resources required, estimated cost savings and timeline for implementation, was approved in January 2009. All proposed testing was implemented by March 2011.ConclusionsKeys to the successful implementation included budgeting adequate resources and developing a realistic timeline, incorporating the changes with the highest budget impact first. We were able to in-source testing in 27 months and save the laboratory approximately $1 million in the first 3 year.