Cost and operational impact of promoting upfront GeneXpert MTB/RIF test referrals for presumptive pediatric tuberculosis patients in India

• Published in: PloS one Vol. 14; no. 4; p. e0214675
• Main Authors: Sarin, Sanjay, Huddart, Sophie, Raizada, Neeraj, Parija, Debadutta, Kalra, Aakshi, Rao, Raghuram, Salhotra, Virender Singh, Khaparde, Sunil D, Boehme, Catharina, Denkinger, Claudia M, Sohn, Hojoon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.04.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Analysis; Bacterial Typing Techniques - economics; Bacterial Typing Techniques - standards; Child; Child health; Child, Preschool; Cities and towns; Cost analysis; Cost assessments; Costs; Demand; Diagnosis, Differential; Diagnostic tests; Economic aspects; Engineering and Technology; Female; Genetic Testing - economics; Genetic Testing - methods; Genetic Testing - standards; Health aspects; Health care costs; Health Care Costs - statistics & numerical data; Health Planning Guidelines; Humans; India - epidemiology; Infant; Infant, Newborn; Laboratories; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Meetings; Molecular Diagnostic Techniques - economics; Molecular Diagnostic Techniques - methods; Molecular Diagnostic Techniques - standards; Occupational health; Outreach programs; Outreach services; Patient Care Team - economics; Patient Care Team - organization & administration; Patient Care Team - standards; Patients; Pediatrics; People and Places; Promotion; Public health; Referral and Consultation - organization & administration; Referral and Consultation - standards; Research and Analysis Methods; Sarin, Sophie; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - economics; Tuberculosis - epidemiology; Work capacity; Workload; Workload - economics; Workload - statistics & numerical data; Workloads; India; Canada; Montreal Quebec Canada; Switzerland; Quebec Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214675

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.