JISCMail - ACB-CLIN-CHEM-GEN Archives

There is a lot of dogma in our subject that is based on assumptions and not evidence. One issue for debate is the theory that bigger is better. For those in Keele benchmarking, there is evidence that can be used to test this theory.

If one plots the number of tests (size) on the x axis, and cost per test on the y axis you get an interesting correlation (n=46). The line is hyperbolic.

The data shows the following. If the work load is small, the unit cost is relatively high. As workload increases the unit cost decreases. However you reach a point (the "sweet spot") where the unit cost does not come down as size increases. This equates to a workload of about 750,000 Keele defined tests per year for Haematology and about 5 million tests per year for Clinical Biochemistry. Increasing the workload above this optimum workload offers little financial advantage.

I would suspect that the shape of the curve is the same the world over but I would suggest that the "sweet spot" can vary between health economies. For the UK this would appear to be about 5 million tests for biochem and 750,000 for haem (I would need to re-analyse the data to get the 95% confidence interval).

I can send the curves on ppt if people wish.

> -----Original Message-----

> From: Clinical biochemistry discussion list

> [mailto:[log in to unmask]] On Behalf Of Jonathan Kay

> Sent: 31 October 2011 15:20

> Subject: Economies of scale

> It's become a dogma in our subject that laboratories with higher workload have lower unit costs. I'm speaking in a debate on "pathology" "networks" and thought it would be a good idea to summarise the evidence for this.

> What's the best piece of evidence you have for this? Would you be prepared to tell me and/or the mailgroup what it is?

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