Pooling Specimens: A Decade of Successful Cost Savings

Background:
The significant expense of molecular nucleic acid amplification testing for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae has restricted routine use for screening programs. An option that offers both sensitive detection and lower cost is testing of pooled specimens. In low incidence populations, pooling is an attractive option to individual specimen testing. UHL has pooled specimens for the past ten years and realized substantial cost savings.

Objective:
To demonstrate that the pooling of endocervical specimens for the detection of C.trachomatis and N. gonorrhoeae can be successfully performed without reduction of sensitivity, using three different instrument platforms.
To review workflow design and implementation of a computerized program to meet the regional turn around time (TAT) of 2 business days.

Method:
Aliquots from each of four individual specimens were added to one vial. Following detection, positive pools are queued for repeat testing of individual specimens.

Result:
Several process changes were made enabling UHL to use the computer for a pooling matrix. During the ten years three different instruments the LCR (Abbott) (Oct 1998-Oct 1992), ProbeTec (BD) (Oct 1992-Jan 2005) and APTIMA COMBO 2 (Gen-Probe) (Jan 2005-present) were used. Regardless of technology used, there was no loss of sensitivity and pooling was successful. The TAT and the number of staff performing the test has remained the same. The average cost savings is calculated to be 60%.

Conclusion:
Pooling specimens in a low incidence population has no adverse impact on sensitivity and saves substantial dollars.

Implications:
Substantial cost savings for IPP screening programs have been realized which allows for the use of the latest molecular technology.