Original Research

Establishing the cost of Xpert MTB/RIF mobile testing in high-burden peri-mining communities in South Africa

Naseem Cassim, Lindi M. Coetzee, Abel L. Makuraj, Wendy S. Stevens, Deborah K. Glencross
African Journal of Laboratory Medicine | Vol 10, No 1 | a1229 | DOI: https://doi.org/10.4102/ajlm.v10i1.1229 | © 2021 Naseem Cassim, Lindi Marie Coetzee, Abel Luke Makuraj, Wendy Susan Stevens, Deborah Kim Glencross | This work is licensed under CC Attribution 4.0
Submitted: 16 September 2020 | Published: 30 November 2021

About the author(s)

Naseem Cassim, Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg, South Africa
Lindi M. Coetzee, Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg, South Africa
Abel L. Makuraj, National Priority Programme, National Health Laboratory Service, Johannesburg, South Africa
Wendy S. Stevens, Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg, South Africa
Deborah K. Glencross, Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Priority Programme, National Health Laboratory Service, Johannesburg, South Africa

Abstract

Background: Globally, tuberculosis remains a major cause of mortality, with an estimated 1.3 million deaths per annum. The Xpert MTB/RIF assay is used as the initial diagnostic test in the tuberculosis diagnostic algorithm. To extend the national tuberculosis testing programme in South Africa, mobile units fitted with the GeneXpert equipment were introduced to high-burden peri-mining communities.

Objective: This study sought to assess the cost of mobile testing compared to traditional laboratory-based testing in a peri-mining community setting.

Methods: Actual cost data for mobile and laboratory-based Xpert MTB/RIF testing from 2018 were analysed using a bottom-up ingredients-based approach to establish the annual equivalent cost and the cost per result. Historical cost data were obtained from supplier quotations and the local enterprise resource planning system. Costs were obtained in rand and reported in United States dollars (USD).

Results: The mobile units performed 4866 tests with an overall cost per result of $49.16. Staffing accounted for 30.7% of this cost, while reagents and laboratory equipment accounted for 20.7% and 20.8%. The cost per result of traditional laboratory-based testing was $15.44 US dollars (USD). The cost for identifying a tuberculosis-positive result using mobile testing was $439.58 USD per case, compared to $164.95 USD with laboratory-based testing.

Conclusion: Mobile testing is substantially more expensive than traditional laboratory services but offers benefits for rapid tuberculosis case detection and same-day antiretroviral therapy initiation. Mobile tuberculosis testing should however be reserved for high-burden communities with limited access to laboratory testing where immediate intervention can benefit patient outcomes.


Keywords

GeneXpert test, tuberculosis screening, mobile testing, costing

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Crossref Citations

1. Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis
Lukas E Brümmer, Ryan R Thompson, Akash Malhotra, Sourya Shrestha, Emily A Kendall, Jason R Andrews, Patrick Phillips, Payam Nahid, Adithya Cattamanchi, Florian M Marx, Claudia M Denkinger, David W Dowdy
Clinical Infectious Diseases  vol: 78  issue: 1  first page: 154  year: 2024  
doi: 10.1093/cid/ciad501