To Reflex or Not to Reflex: A Time and Cost-Effectiveness Analysis of Autocontrol with Reflex DAT versus Direct DAT

Performing autocontrol with a reflex direct antiglobulin test (DAT) or directly performing IgG DAT only for alloantibody detection has been a matter of institutional preference. The aim of this study is to evaluate antibody identification (ABID), local cost, and staff time savings of both processes.

We retrospectively reviewed all positive indirect antiglobulin tests with corresponding ABID, DAT, autocontrol, and patients with newly identified antibodies in 2014 and 2016. The number of tests performed, ABID, and the cost differences between methods were compared. Cost analysis was estimated from direct material costs, labor costs, and time spent per ABID workup.

Annual costs and time saved by performing direct IgG DAT only were $8460 and 180 hours, respectively. The percentage of new ABID in 2014 and 2016 was identical (3.3%).

Removing autocontrol with reflex DATs at our center reduced costs and staff time while maintaining a comparable rate of positivity of ABID.