Cost Comparison of Point-Of-Care and Conventional CD4 Testing in Resource-Limited Settings
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Cost Comparison of Point-Of-Care and Conventional CD4 Testing in Resource-Limited Settings Ilesh V. Jani Instituto Nacional de Saúde Maputo, Mozambique
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Cost Comparison of Point-Of-Care and Conventional CD4 Testing in Resource-Limited Settings. Ilesh V. Jani Instituto Nacional de Saúde Maputo, Mozambique. Nurses in Primary Health Clinics Can Accurately Perform CD4 counts Using Point-Of-Care Devices. Alere PIMA (Lab Techs) - PowerPoint PPT Presentation
Transcript of Cost Comparison of Point-Of-Care and Conventional CD4 Testing in Resource-Limited Settings
Cost Comparison of Point-Of-Care and Conventional CD4 Testing in
Resource-Limited SettingsIlesh V. Jani
Instituto Nacional de SaúdeMaputo, Mozambique
Alere PIMA (Lab Techs) vs. BD FACSCalibur
Alere PIMA (Nurses) vs. BD FACSCalibur
Limits of Agreement -314 to +257 Limits of Agreement -249 to +148
Jani et al. (2011); AIDS
Nurses in Primary Health Clinics Can Accurately Perform CD4 counts Using Point-Of-Care Devices
Baselin
e _x000d_(N
ov 2009)
Post-Pilo
t _x0
00d_(Mar 2
010)0%
20%
40%
60%
80%
100%
55.2%
92.9%
44.8%
7.1%
Access to CD4 No Access to CD4
Percent Of Patients Receiving CD4 Test Results
Baselin
e _x000d_(N
ov 2009)
Post-Pilo
t _x0
00d_(Mar 2
010)0%
20%
40%
60%
80%
100%
28.4%
79.4%
71.6%
20.6%
Return After CD4 No Return After CD4
Percent Of Patients ReturningAfter Initial CD4
Point-Of-Care CD4 Counting Reduces Pre-Treatment Loss-To-Follow-Up
Conventional CD4 (BD FACSCount)• Higher throughput (50-75
tests/day)• Large installed base (>1000
instruments across Africa)• Takes advantage of existing
infrastructure• Performed by trained
laboratory technicians• May be more efficient and
cheaper due to economies of scale
Point-Of-Care CD4 (Alere Pima)• Lower throughput (5-20
tests/day)• New technology without
large installed base• Does not require significant
infrastructure• Performed by non-
specialised personnel• May be more expensive in
certain settings• Significant patient benefits
Point-Of-Care Technologies Must Be Considered Against Conventional Laboratory-Based technologies
Methods
• Data were gathered from health facilities across 13 countries in sub-Saharan Africa:
• Reagent, control, and consumable costs• Equipment and maintenance costs• Lab infrastructure and overhead costs• Sample transport costs• Human resource salaries• Site patient volumes
• Total cost per test for a site with known testing volume was calculated to determine if it would be less costly to refer samples to an existing CD4 laboratory or to implement Point-Of-Care CD4 testing on-site
Cost is an Important Factor to Consider When Placing Point-Of-Care Devices
Conventional CD4 testing Costs Vary Significantly But Point-Of-Care CD4 Counting Costs Are Relatively Stable Across Countries
Cost Component Price Range Price Range
Reagents $4.22 - $10.89 $5.95 plus distributor margin
Other Consumables $0.55 - $1.61 $1.00Controls $0.15 - $0.52 $100 per yearPrice per Instrument $27,000 (FACSCount) $5,000 (PIMA)Maintenance $4,000 per year $1,200 per yearFreight 10% of costs 10% of costsLab Overhead $0.18 - $0.46 $0.52 - $0.60Sample Transport ~$1.25 per sample1 NoneHuman Resources $0.32 - $2.10 $0.16 - $1.15
Source: 1Machinga District, Malawi
Conventional CD4 POC CD4$0.00
$2.00
$4.00
$6.00
$8.00
$10.00
$12.00
$14.00
$5.60 $6.55
$1.09$1.30$0.70
$1.95$1.25
$0.88 $0.81
$10.50
$11.78
Human ResourcesSample TransportationLab OverheadFreightEquipmentControlsConsumablesReagents
At Average Volumes of ~1,400 Tests/Yr Point-Of-Care CD4 Cost/Test is Comparable to Conventional CD4
Averages obscure higher reagent prices for laboratory based CD4 in some countries
500 1000 1500 2000 2500 3000 3500 4000 4500 5000$8.00$9.00
$10.00$11.00$12.00$13.00$14.00$15.00$16.00$17.00$18.00
Conventional CD4
CD4
Cost
per
Test
CD4 Volume per Year per Site
For a Single ART Site Referring Samples, Conventional CD4 Cost/Test Drops Slightly as Volumes Rise
500 1000 1500 2000 2500 3000 3500 4000 4500 5000$8.00$9.00
$10.00$11.00$12.00$13.00$14.00$15.00$16.00$17.00$18.00 Point Of Care CD4
CD4
Cost
per
Test
CD4 Volume per Year per Site
For a Single ART Site with Point-Of-Care CD4, Cost/Test Drops Dramatically as Volumes Rise
Above 5,000 tests/year, a 2nd
device is required
500 1000 1500 2000 2500 3000 3500 4000 4500 5000$8.00$9.00
$10.00$11.00$12.00$13.00$14.00$15.00$16.00$17.00$18.00
Conventional CD4 Point Of Care CD4
CD4
Cost
per
Test
CD4 Volume per Year per Site
At 1,400 tests/yr per site (avg. CD4 demand at a health center in Africa),
POC all-in costs are higher
Cost is equal at ~2,900 tests per year at one site
As Testing Volumes Rise, Point-Of-Care CD4 Testing Becomes More Cost-Competitive
0 13 26 39 52 65 78 91 1041171301431561691821950
10,000
20,000
30,000
40,000
50,000
Sites in Mozambique without CD4 On-Site,by CD4 Test Demand
CD4 Tests Demanded/Year
Higher Volume Sites Comprise a Large Proportion of Point-Of-Care Test Demand
Sites above >2,900 tests per year comprise >90% of
CD4 test demand But it is more intuitive that POC would belong at
small, remote sites!
Deploying Device Based Point-Of-Care CD4 at a (relatively) Modest Number of Higher Volume Sites Seems to Be Less Costly - But Site Selection Depends on Many Factors
• Other factors to consider:– Universal access– Equity – Distance to laboratories– Patient loss-to-follow-up– Size of catchment area– ART coverage– HIV prevalence– PMTCT services– Etc.
Kanimambo!Obrigado!
Grazie!Thank You!
