Can TDABC (Time-Driven Activity-Based Costing) help the NOVO hospital’s medical biology laboratory to value the appropriate prescription? – Role of the biologist in reducing healthcare costs

The relevant and correct prescribing of medical biology is a major public health issue. Correct prescribing is a legal obligation under article L6211-8 of the French Public Health Code and is an integral part of the biologist's daily work, already specified in the 2012 (section 4.7) and 2022 (section 5.3.3) versions of the NF EN ISO 15189 standard. COFRAC document SH REF 02 v08 specifies the requirements for consultancy services. The adaptation of the prescriptions is a revision of the contract with the prescriber, which makes it possible to optimize patient care and ensure the satisfaction of the laboratory users. Although essential, accurate prescribing is time consuming. "Chronophage" is the term that has been used for almost a decade. At present, the work of biologists in this area is not valued. In fact, there is no evaluation system to highlight this regulation control activity. To date, no work has been published to estimate this time, this chronophagy, and to evaluate its impact. Cost measurement using Time-Driven Activity-Based Costing (TDABC), a variant of Activity-Based Costing (ABC), is based on a process approach. The main contribution of TDABC is that it uses a single cost driver: time. Serum immunofixation is a test used to confirm and monitor plasma cell dyscrasias, the archetype of which is multiple myeloma. The learned societies and the IMWG provide explicit diagnostic criteria, but the guidelines do not address the frequency of follow-up. In particular, the frequency of repeat and follow-up serum immunofixation remains unaddressed from an evidence-based medicine perspective. This work has made it possible to highlight the savings made between 1st January and 31th August 2023 thanks to the involvement of the biologist and to highlight his essential role in the process of controlling the overall expenditure (reagents, human resources, time and money) in the specialized biochemistry sector (bench: proteins) and to strengthen the role of the biologist within the institution. The various players in the healthcare sector - prescribing physicians, biologists, hospital administrators and, last but not least, patients - all have an essential role to play in maximizing value for patients and in the healthcare economy.