Clinical laboratories today require increased efficiency through automation as a way of achieving greater throughput without increasing the skilled labor costs. This is certainly true with regard to automation in immunohistochemistry (IHC) slide staining. The automation of more steps, including deparaffinization and heat-induced epitope retrieval (HIER), provides walk-away capability. Using elements of automation such as barcodes and/or RFID tags to track reagent usage prevents downtime by alerting lab personnel when reagents are low and need to be replaced or ordered. To fully understand the cost of performing IHC slide staining procedures, it is important for lab managers to know the total cost of operating and maintaining the instrument.
Many early, or first generation, automated IHC slide stainers did not include slide heating and, therefore, could not perform online HIER. Heating is critical for effective antigen retrieval in order to break the epitope crosslinking formed during formalin fixation. Advances in technology over time have allowed for on-board heating capability at a reasonable cost in later generations of automated slide staining instruments. Although HIER may be performed manually with only minutes of hands-on time and lower operating costs, online HIER within an automated workflow is desirable for many lab managers who want to set up an IHC slide staining procedure and give staff the convenience of walking away and attending to other work. Another added advantage of slide heating is the capability to perform in situ hybridization protocols on the same instrument.
When shopping for an automated IHC slide staining system, a lab manager needs to capture all cost considerations. Some needs that are often overlooked are whether STAT access is important, whether there are any unique protocols that will require a system having open access, or whether multiplex capability is required. The specific needs and throughput for any laboratory must be determined before a system is selected. Lab managers should analyze the types of tests being performed and the throughput today and projected for the future to determine what staining platform best suits evolving needs. Once all the requirements have been gathered, they should rank their priorities to see what is really necessary, as opposed to “bells and whistles” that can be sacrificed. They should consider multiple staining platforms when a single platform does not fully cover the defined requirements.
One cost that is often neglected is hazardous waste disposal. Waste regulations vary widely by region, so it is best for decision makers to contact their local hazardous waste management team to find out the disposal regulations and costs in their area. The types of waste generated also differ from instrument to instrument and depending on which detection systems and reagents are used in the IHC staining protocol. Another hidden cost is maintenance. The time and skill level required impact labor costs, while any specialty kits or reagents required impact operating costs.
Performing a comparison of automated IHC slide staining systems looking at specifications alone would provide only part of the picture a manager needs to view to make a good purchasing decision. Most of the instruments available on the market today provide good staining quality. In the current economic environment, controlling costs is increasingly important when considering a system. It is wise to estimate the total cost of owning and operating the system over the four-to-five-year period the system will be in the lab, and to look for full disclosure of the cost of ownership.
Lab directors need to calculate their cost per slide; this is a good way to compare systems. Cost per slide is calculated based on the volume of each reagent and antibody applied to the slide and the prices of the reagents and antibodies. When purchasing the system as a capital purchase, or as part of a reagent rental/lease agreement, savvy managers factor in all of the costs, including reagents, accessories and consumables, maintenance and upkeep, and any service contracts. When calculating a cost per slide, they capture all the related costs, including any special accessories, and aim for full disclosure and transparency.