Financial justification of alternate site testing

Fixed costs are higher and variable costs lower for clinical laboratory testing than for alternate-site testing (AST). For AST to become cost-effective, variable costs must be reduced. Four models for accounting for the costs of clinical laboratory testing and AST are compared. A common error is to omit some of the indirect costs of a cost-per-test analysis for AST, thereby providing false claims. For a cost-per-test analysis, we recommend that identical categories be used for both the central laboratory and for AST. However, cost-per-test data alone do not completely represent institutional costs or savings associated with laboratory testing at any site.