• Jesse Theisen-Toupal, Gary L Horowitz, and Anthony C Breu.
• Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. jtoupal@bidmc.harvard.edu
• J Hosp Med. 2013 Feb 1;8(2):91-5.

BackgroundSerum folate levels are commonly ordered for multiple indications in the inpatient and emergency department settings. Since mandatory folic acid fortification in 1998, there has been a decreasing prevalence of folate deficiency in the United States.ObjectiveOur objective was to determine the indications, rate of deficiency, charge and cost per deficient result, and change in management per deficient result in serum folate testing in inpatients and emergency department patients.DesignRetrospective analysis of all inpatient and emergency department serum folate tests.MethodsWe analyzed all inpatient and emergency department serum folate tests performed over a 12-month period. We reviewed the charts of 250 patients and all low-normal or deficient serum folate levels to determine indications, comorbidities, and change in management based on result. Charge and cost analyses were performed.Setting/PatientsAll inpatient and emergency department patients with a serum folate test performed at a major medical center in Boston, Massachusetts.ResultsA total of 2093 serum folate tests were performed in 1944 patients with 2 deficient levels. The most common indications were anemia without macrocytosis and anemia with macrocytosis. The amount charged per deficient result was $158,022. The cost to the hospital per deficient result was less than $2093.ConclusionsIn folic acid fortified countries, serum folate testing has low utility and poor cost effectiveness for all indications in inpatients and emergency department patients.Copyright © 2012 Society of Hospital Medicine.

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