Estimating the Cost of Point-of-Care Early Infant Diagnosis in a Program Setting: A Case Study Using Abbott m-PIMA and Cepheid GeneXpert IV in Zimbabwe
Estimating the Cost of Point-of-Care Early Infant Diagnosis in a Program Setting: A Case Study Using Abbott m-PIMA and Cepheid GeneXpert IV in Zimbabwe
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DOI：
10.1097/qai.0000000000002371
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发表时间：
2020-07-01
影响因子：
3.6
通讯作者：
Turunga, Esther
中科院分区：
文献类型：
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作者：
Mukherjee, Sushant M. A.;Cohn, Jennifer;Turunga, Esther
背景：与以中心实验室为基础的早期婴儿诊断相比，早期婴儿诊断(POC EID)增加了获得艾滋病毒检测结果的机会，缩短了结果返回和抗逆转录病毒治疗开始的时间。然而，为了扩大POC EID，政府需要更多关于计划成本的信息。方法：我们从卫生系统的角度评估POC EID成本。我们的初步分析评估了雅培m-PIMA和2个版本的Cepheid GeneXpert IV平台-使用太阳能电池或凝胶电池-在津巴布韦使用，并购买了仪器。我们还包括了以下两种预购设备的场景：(1)使用试剂租赁模型的m-PIMA，当买方承诺平均检测量时，价格包含一切；(2)GeneXpert IV，反映了GeneXpert已经用于结核病诊断或艾滋病毒病毒载量监测的背景。我们从项目支出、卫生工作者的观察和政府工资表中收集数据。根据每台机器每天进行的EID检测次数计算每次EID检测的成本。结果：购买平台的m-PIMA每成功完成一次检测的成本为44.55美元，租用m-PIMA试剂的成本为25.89美元。使用太阳能电池的GeneXpert IV平台购买成本为25.70美元，使用凝胶电池的成本为25.29美元，假设没有设备成本的情况下为23.85美元。在我们的初步分析中，材料成本占总成本的73%-74%，设备成本占14%-20%，劳动力成本占5%-8%，培训成本占1%，设施升级成本占1%，监控成本占1%。结论：随着各国考虑扩大POC EID，这些数据对于预算和规划非常重要。
Background:Point-of-care early infant diagnosis (POC EID) increases access to HIV test results and shortens time to result-return and antiretroviral therapy initiation, as compared to central laboratory-based EID. However, to scale-up POC EID, governments need more information about programmatic costs.Methods:We evaluated POC EID costs from a health systems perspective. Our primary analysis assessed the Abbott m-PIMA and 2 versions of the Cepheid GeneXpert IV platforms—with a solar battery or gel battery—used in Zimbabwe, with instrument purchase. We also included the following 2 scenarios with zero upfront equipment purchase:(1) m-PIMA using a reagent rental model, with an all-inclusive price when the buyer commits to an average testing volume, and (2) GeneXpert IV, reflecting contexts where GeneXpert is already in place for tuberculosis diagnosis or HIV viral load monitoring. We collected data from project expenditures, observations of health workers, and from government salary scales. We calculated cost per EID test based on number of EID tests performed on each machine per day.Results:The cost per successfully completed test was $44.55 for m-PIMA with platform purchase and $25.89 for m-PIMA reagent rental. Costs for GeneXpert IV with platform purchase were $25.70 using a solar battery, $25.29 using a gel battery, and $23.85 under a scenario assuming no equipment costs. In our primary analyses, materials costs comprised 73%–74% total costs, equipment 14%–20%, labor 5%–8%, training 1%, facility upgrades 1%, and monitoring 1%.Conclusions:As countries consider scaling up POC EID, these data are important for budgeting and planning.