3
Veterinary Medical Care

Veterinary medical care is an essential component of any animal care and use program. The size, scope, and function of the veterinary care program depend on the extent and type of animal care and use. Specific factors that influence the program of veterinary care include the number and type of animal species, the disease backgrounds of animal species maintained, the numbers of animals used, and the experimental characteristics and requirements of the animal models necessary to satisfy research objectives. At a minimum, the veterinary medical care program must be sufficiently robust to satisfy regulatory requirements. Ideally, it is comprehensive and fully integrated into the fabric of the institution, providing demonstrable contributions to the goals of the institution, the research programs, and the overall animal care and use program. In the development of a program of veterinary medical care, there are decision points concerning staffing, sophistication of diagnostic support, and intensity of disease surveillance, which can have considerable cost implications.

Cost effectiveness is an important concern and goal in today's competitive research environment, but quantifying the return on investment in veterinary medical care is difficult. For example, costs associated with a disease outbreak or loss of animals in a specific study could be estimated, but the relationship of the expected frequency of such occurrences to the composition of the veterinary medical program is difficult to assess. Also, relief from the boredom of repetitive tasks is often achieved by rotating assignments among the veterinary care staff, and this further complicates efforts to quantify and analyze cost effectiveness. For ex-



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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES 3 Veterinary Medical Care Veterinary medical care is an essential component of any animal care and use program. The size, scope, and function of the veterinary care program depend on the extent and type of animal care and use. Specific factors that influence the program of veterinary care include the number and type of animal species, the disease backgrounds of animal species maintained, the numbers of animals used, and the experimental characteristics and requirements of the animal models necessary to satisfy research objectives. At a minimum, the veterinary medical care program must be sufficiently robust to satisfy regulatory requirements. Ideally, it is comprehensive and fully integrated into the fabric of the institution, providing demonstrable contributions to the goals of the institution, the research programs, and the overall animal care and use program. In the development of a program of veterinary medical care, there are decision points concerning staffing, sophistication of diagnostic support, and intensity of disease surveillance, which can have considerable cost implications. Cost effectiveness is an important concern and goal in today's competitive research environment, but quantifying the return on investment in veterinary medical care is difficult. For example, costs associated with a disease outbreak or loss of animals in a specific study could be estimated, but the relationship of the expected frequency of such occurrences to the composition of the veterinary medical program is difficult to assess. Also, relief from the boredom of repetitive tasks is often achieved by rotating assignments among the veterinary care staff, and this further complicates efforts to quantify and analyze cost effectiveness. For ex-

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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES ample, it is not uncommon for a veterinarian to be responsible for specific research project support, administrative duties, and veterinary medical care responsibilities. Understanding the potential risks (such as disease outbreaks) of a minimal or poorly functioning program is essential to designing a veterinary medical care program that is reasonable and cost-effective. An assessment of research program needs and regulatory requirements is critical to development of a cost-effective veterinary care program. The assessment should be followed by an effort to design and establish an integrated veterinary medical care program that remains interactive with the research staff and efficient in the delivery of veterinary care while satisfying disparate institutional needs. Making periodic adjustments to the program in an environment of changing research directions and new technologies requires frequent interactions with key personnel in research and administration. VETERINARY STAFFING Compensation for professional staff can constitute the greatest operational cost for the veterinary medical care program, and portions of it are often subsidized (Table 23a, Appendix C). Increased numbers of specialty-trained veterinarians are being employed by research institutions as the science and technology of laboratory animal medicine and veterinary medical care advance and their value to research organizations is increasingly recognized. In addition, the growing regulatory burden (NIH 1999) has increased the involvement of specialty-trained veterinarians, particularly laboratory animal veterinarians, in biomedical research institutions. The higher cost of using veterinary specialists has prompted some institutions to look for ways to contain cost through management techniques such as delegation, empowerment, and teamwork to optimize the use of talent. Consultants and part-time employees, both veterinarians and animal care staff, can also be useful in some settings if oversight is adequate to ensure quality and regulatory compliance. Laboratory animal veterinarians are variously employed by institutions as animal care and use program directors, managers, and clinical veterinarians. Depending on the size and function of the veterinary care program, one or more veterinarians might be needed to satisfy institutional needs. Veterinarians' salaries are higher than those of other veterinary support personnel, so institutions should make use of the veterinarians so as to take full advantage of their professional competences while technical and administrative duties are delegated to lower-paid employees (Gehrke and others 2000). Veterinary residents and certified laboratory animal and veterinary technicians can be used as an effective exten-

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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES sion of the veterinary medical staff, as noted in the CIC Study ( Appendix B). In addition, in circumstances where a veterinarian is required only part-time, institutions can choose to use consultants, share positions with other institutions, or use the veterinarians' professional competences in research or research-support activities. In the latter case, collaboration between the veterinary staff and the research staff might translate into cost savings for both because a veterinarian would provide skilled assistance while performing required oversight. Important factors in determining the appropriate level of staffing of veterinarians are the mix of species, the presence or absence of a surgery program, and the use of animal models that require intensive veterinary oversight and assistance because of experimental complications, invasive procedures, or spontaneous disease. Rodent-only programs might require less clinical veterinary support than programs that use larger species or involve animal models entailing surgery or other invasive manipulations that affect animal health and welfare. In the committee's experience, many institutions are finding that transgenic animals require more veterinary support than standard rodent models to deal with breeding issues, health problems associated with unique phenotypes, and the requirement for closely observing the animals for unusual health and animal husbandry problems. In addition, these animals are extensively exchanged among investigators within the country and internationally, increasing the requirement for clinical and diagnostic health assessment programs. Veterinary medical care requirements for surgery-intensive programs include such services as preoperative and postoperative care, diagnostic services, treatment, surgery, and specialized facilities and equipment. TECHNICIANS Trained and highly competent technicians are increasingly viewed by institutions as required for efficiently delivering veterinary medical care services in support of higher-paid veterinarians. Many institutions have minimized costs, maximized the use of personnel, and provided valuable career opportunities by delegating responsibility for performing a wide variety of standard veterinary techniques— and advanced research and surgical assistance—to talented and technically proficient veterinary technicians. DIAGNOSTIC LABORATORY SUPPORT Clinical pathology laboratory support is a critical component of a high-quality veterinary medical care program. Involving a laboratory-

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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES animal-trained veterinary pathologist enhances the quality of such laboratories. Hematology, biochemistry, parasitology, microbiology, and histopathology laboratory services are necessary for disease diagnosis, health surveillance, vendor animal health assessment, and research support. The type and volume of diagnostic laboratory support depend on a variety of factors, including program size, species mix, surgical load, source of animals, and research-support requirements. Institutions must decide, on the basis of cost and quality, whether services should be developed internally, referred to outside contract laboratories, or a combination of the two. Inhouse laboratories are generally more responsive and can be tailored to the species being used. However, startup, staffing, and space costs can be considerable. In contrast, contract laboratories, although not always able to be as responsive as inhouse laboratories, can often deliver services at a lower cost because of economies of scale and a broader testing repertoire. There are some inherent shortcomings in some contract laboratories, including availability in the region of the facility, unfamiliarity with animal specimens or animal diseases, and quality control. Appropriate quality control should be exercised if the results are to yield high-quality research data. For most small to medium institutions, a combination of minimal inhouse laboratory support with the use of outside contract diagnostic laboratories is most cost-effective. Another option is to share resources among several institutions; this results in cost savings and improves program quality. In large institutions, a dedicated laboratory that is appropriately staffed and equipped might be cost-effective and more responsive. Technologic advances have led to kits for rapid, inexpensive inhouse serologic testing for common rodent viruses and a variety of other assays, allowing smaller institutions to perform some of their own laboratory testing cost-effectively. Many institutions have also found it possible, with little investment, to augment existing research or hospital laboratories and use existing personnel to meet their laboratory animal needs while decreasing overall costs. The optimal approach or combination of approaches can be determined only through careful case-by-case analysis. HEALTH SURVEILLANCE An appropriately designed animal health assurance program addresses prevention, control, and treatment of animal disease. The increasingly widespread availability and use of microbiologically defined animal models and the growing recognition of the confounding microbial effects of infections and other diseases has created a substantial demand for health-surveillance programs that monitor the microbiologic status of

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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES laboratory animal populations. Also, there is a need to determine the microbiologic status of tumors, cell lines, and other products of animal origin that might be injected into research animals. Cost components include salaries for veterinarians and technicians and laboratory costs for diagnostic and surveillance testing. Researchers are increasingly sharing animals among institutions—animals that could have an unknown health status. This practice has led to an increased need for health surveillance. As animal-housing technology and facility design improve, the maintenance of disease-free, microbiologically defined animals has become a nearly universal standard of care, increasing the importance of disease surveillance (NRC 1996, pg. 27-30). The planning of health-surveillance programs must include identification of the target populations, definition of program elements, frequency of testing, and methods to be used (NRC 1996, pg. 85-113). Each is evaluated in the context of the species, sources, facility design, and housing conditions; and an approach for each set of circumstances should be determined. Once the target populations are identified and specific program elements—such as vendor surveillance, disease prophylaxis or vaccination, routine observation and reporting, microbiologic monitoring, and histopathologic examination—have been identified, the more difficult task of determining the frequency of testing and the preferred methods must be resolved. Health surveillance is expensive, and many institutions strive to develop a cost-effective program. In particular, the cost of sampling a statistically significant portion of the total population in a surveillance program is often prohibitive. Detecting disease in microbarrier caging systems requires sampling nearly every cage over time by the transfer of bedding to sentinel cages. Consequently, after a careful and informed analysis of risk, staff might opt to reduce costs by lowering the frequency of testing or using less-expensive screening tests initially and then more definitive and more expensive tests as deemed necessary. SUMMARY In summary, the major finding and opinions expressed in this chapter are as follows: Veterinary medical care programs should be carefully designed to maximize use of the specialist's time by using managers, visiting residents, and certified laboratory animal veterinary technicians. The level of veterinary medical care depends on the species mix, size of surgery program, and complexity of animal models used in research.

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STRATEGIES THAT INFLUENCE COST CONTAINMENT IN ANIMAL RESEARCH FACILITIES Diagnostic laboratory support is a critical component of the veterinary medical care program and can be provided by inhouse laboratories, contract laboratories, or a combination of the two. A well-designed health-surveillance program that ensures higher-quality animals is critical to obtaining accurate research results. The surveillance program must be appropriate to needs yet contain costs.