Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management

Clin Chim Acta. 2013 Jun 25;422:10-4. doi: 10.1016/j.cca.2013.03.010. Epub 2013 Mar 29.


Introduction: Reference laboratory testing can represent a significant component of the laboratory budget. Therefore, most laboratories continually reassess the feasibility of in-sourcing various tests. We describe the transfer of urine drug testing performed for monitoring medication compliance in pain management from a reference laboratory into an academic clinical laboratory.

Methods: The process of implementing of both screening immunoassays and confirmatory LC-MS/MS testing and the associated cost savings is outlined.

Results: The initial proposal for in-sourcing this testing, which included the tests to be in-sourced, resources required, estimated cost savings and timeline for implementation, was approved in January 2009. All proposed testing was implemented by March 2011.

Conclusions: Keys to the successful implementation included budgeting adequate resources and developing a realistic timeline, incorporating the changes with the highest budget impact first. We were able to in-source testing in 27 months and save the laboratory approximately $1 million in the first 3 year.

MeSH terms

  • Buprenorphine / urine
  • Chromatography, Liquid
  • Cost Savings*
  • Drug Monitoring / economics*
  • Fentanyl / urine
  • Humans
  • Medication Adherence* / statistics & numerical data
  • Morphine Derivatives / urine
  • Pain Management / economics*
  • Tandem Mass Spectrometry
  • Tramadol / urine
  • Urinalysis / economics*


  • Morphine Derivatives
  • Tramadol
  • Buprenorphine
  • 6-O-monoacetylmorphine
  • Fentanyl