Substantial international variation in the cost of blood group and save and crossmatch: A systematic review

Blood transfusion is one of the most common interventions in hospitals. Blood tests that support this widespread practice are considered routine, such as 'group and save' (also known as 'type and screen'), yet there has been very limited evaluation of the needs for these tests and the associated costs. The aim of this systematic review is to synthesise international evidence on the costs of group and save and crossmatch tests and their component processes. Seventy-two studies published between 2012 and 2023 were identified and data were extracted. Most cost estimates were derived from local institutional sources with few using national reference data, and reporting methods varied widely. Median unit costs for group and save tests were £19.8 (interquartile range [IQR] £11.8-£52.5) overall, £13.8 in the United Kingdom and £57.4 in the United States. Crossmatch costs were £9.6 (IQR £5.9-£37.3). Understanding costs for group and save testing will inform hospital teams making decisions about sample requirements for procedures with a low likelihood of transfusion. It also provides benchmarking to assess the impact of implementing electronic systems to improve safety and efficiency of transfusion practice.