P089Rh-immunoglobulin administration for patients with first-trimester bleeding: Estimating the cost to the healthcare system

Abstract

<h3>Objectives</h3> Administration of Rh-immunoglobulin remains standard practice in many settings in the US despite lack of evidence supporting clinical benefit. We sought to estimate the cost of this practice to both freestanding clinics and academic abortion care settings. <h3>Methods</h3> Time-driven activity-based costing was used to analyze tasks associated with blood typing and Rh-immunoglobulin administration, when indicated, for all patients with first-trimester bleeding at a large academic family planning center. Tasks were also reviewed at two freestanding abortion clinics. Process maps were created for each setting, and costs for Rh-positive and Rh-negative patients were estimated. <h3>Results</h3> At the freestanding abortion clinics, which used finger sticks to type patients, per-patient costs were $46.60 if Rh-positive and $205.18 if Rh-negative. At the academic institution, per-patient costs were $78.55 if Rh-positive and $210.27 if Rh-negative for patients with a documented historical blood type. Costs were $172.01 if Rh-positive and $362.19 if Rh-negative for patients requiring phlebotomy due to lack of documented blood type. Total monthly clinic costs associated with blood typing and Rh-immunoglobulin administration in the first trimester ranged from $11,131.69 in the lower-volume academic setting to $49,514.21 in the freestanding clinic with the highest patient volume. <h3>Conclusions</h3> Blood typing and Rh-immunoglobulin cost up to half a million dollars annually per clinic, with even Rh-positive patients with a previously documented blood type contributing significant costs. These time-based costing results highlight the burden of this practice to the healthcare system and provide an argument for reassessing the value of Rh-immunoglobulin administration in the first trimester.