Cost and operational impact of promoting upfront GeneXpert MTB/RIF test referrals for presumptive pediatric tuberculosis patients in India.
Adolescent
Bacterial Typing Techniques
/ economics
Child
Child, Preschool
Diagnosis, Differential
Female
Genetic Testing
/ economics
Health Care Costs
/ statistics & numerical data
Health Planning Guidelines
Humans
India
/ epidemiology
Infant
Infant, Newborn
Male
Molecular Diagnostic Techniques
/ economics
Patient Care Team
/ economics
Referral and Consultation
/ organization & administration
Tuberculosis
/ diagnosis
Workload
/ economics
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
30
11
2018
accepted:
18
03
2019
entrez:
2
4
2019
pubmed:
2
4
2019
medline:
14
1
2020
Statut:
epublish
Résumé
Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider's perspective and expressed in 2015 USD. Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.
Sections du résumé
BACKGROUND
Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities.
METHODS
Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider's perspective and expressed in 2015 USD.
RESULTS
Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals.
CONCLUSIONS
Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.
Identifiants
pubmed: 30933997
doi: 10.1371/journal.pone.0214675
pii: PONE-D-18-34370
pmc: PMC6443160
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0214675Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Health Policy Plan. 1999 Dec;14(4):374-81
pubmed: 10787653
Int J Tuberc Lung Dis. 2017 Apr 1;21(4):375-380
pubmed: 28284251
PLoS Med. 2011 Nov;8(11):e1001120
pubmed: 22087078
Health Policy Plan. 2000 Jun;15(2):230-4
pubmed: 10837047
Health Econ. 2016 Feb;25 Suppl 1:53-66
pubmed: 26763594
PLoS One. 2018 Feb 28;13(2):e0193194
pubmed: 29489887