Estimating the environmental impact of inappropriate laboratory testing
Letter to the Editor

Estimating the environmental impact of inappropriate laboratory testing

Giuseppe Lippi1, Massimo Daves2

1Section of Clinical Biochemistry, University of Verona, Verona, Italy; 2Immunohaematology and Transfusion Service, Hospital of Bolzano, Bolzano, Italy

Correspondence to: Prof. Giuseppe Lippi. Section of Clinical Biochemistry, University Hospital of Verona, P.le LA Scuro 10, 37134-Verona, Italy. Email: giuseppe.lippi@univr.it.

Response to: Watine J. Overusing laboratory tests: why is it unethical? J Lab Precis Med 2017;2:47.


Received: 21 July 2017; Accepted: 21 July 2017; Published: 09 August 2017.

doi: 10.21037/jlpm.2017.07.10


In a recent letter commenting a previous article published in the Journal of Laboratory and Precision Medicine (1), Joseph Watine has outlined an intriguing and almost overlooked consequence of inappropriate laboratory testing, i.e., the potential impact of redundant or unnecessary tests on environmental protection (2). Notwithstanding this concept is theoretically straightforward, Watine failed to provide significant data in support of this statement, which hence remains hypothetical in essence.

To obtain a more reliable and touchable picture, we have made some speculative calculations for estimating the potential economic and environmental impact of wastage attributable to laboratory inappropriateness. According to the local facility (i.e., the laboratory of Clinical Chemistry and Hematology of the University Hospital of Verona, Italy), the global consumption of and cost per test of water, energy and personnel resources for clinical chemistry and immunochemistry testing performed on the analyzer Roche Cobas 6000 testing (two c501 modules and one e601 module; Roche Diagnostics GmbH, Mannheim, Germany) (Figure 1) are shown in Table 1, as estimated by the current tender and manufacturer’s declaration (3). Overall, each inappropriate test may hence impact by approximately 0.286€ on the hospital budget, 0.2% of which attributable to wastage of water, 3.2% to wastage of energy and 2.2% due to unnecessary personnel cost.

Figure 1 Manufacturer’s specifications for the clinical chemistry and immunochemistry analyzer Roche Cobas 6000 (i.e., configuration c501-c501-e601).
Table 1
Table 1 Consumption of and cost per test of water, energy and personnel for clinical chemistry and immunochemistry testing performed in the local laboratory, using the analyzer Roche Cobas 6000 (i.e., configuration c501-c501-e601) (Figure 1)
Full table

According to recent statistics, the current consumption of water, electric energy and the overall number of laboratory tests performed per year in Italy are approximately 5,348,272 million liters, 342,379 GWh and 668.8 million tests, respectively. Even assuming the worst scenario in clinical chemistry and immunochemistry (i.e., 30% of unnecessary/redundant tests) (4), the overall impact of laboratory inappropriateness in clinical chemistry and immunochemistry (i.e., the largest diagnostic area) would hence expectedly account for less than 0.0002% of total water consumption and less than 0.0001% of total electric consumption in Italy.

Can these figures be considered really meaningful in terms of environmental protection? Although we do not have a definitive answer to this question, and with the awareness that water and energy consumption for inappropriate laboratory tests is a very tiny drop in the immense ocean of human wastage of resources (as for our speculative calculations), the comment of Joseph Watine should be cherished since it adds more, though substantially weak, evidence that additional efforts should be made to reduce the burden of laboratory inappropriateness. Yet, environmental protection inside and outside the laboratory probably would much more benefit from other types of interventions, such as repairing water leaks and leaky toilets, installing water aerators and systematically shutting-off ancillary services to reduce energy use and maintenance requirement, unplugging equipment and turning off lights when not in use, using available sunlight to illuminate work spaces or switching to compact fluorescent bulbs.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Montagnana M, Lippi G. Overusing laboratory tests: more advantages or drawbacks? J Lab Precis Med 2017;2:41. [Crossref]
  2. Watine J. Overusing laboratory tests: why is it unethical? J Lab Precis Med 2017;2:47. [Crossref]
  3. Roche Diagnostics. Cobas® 6000 analyzer series-Operator’s Manual Software Version 05-02. Roche Diagnostics GmbH, Mannheim, Germany.
  4. Lippi G, Bovo C, Ciaccio M., et al. Inappropriateness in laboratory medicine: an elephant in the room? Ann Transl Med 2017;5:82. [Crossref] [PubMed]
doi: 10.21037/jlpm.2017.07.10
Cite this article as: Lippi G, Daves M. Estimating the environmental impact of inappropriate laboratory testing. J Lab Precis Med 2017;2:52.

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