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

Abstract

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.

Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study

“…Accurate calculations of caseload per clinic and costs data are essential in deciding on how to best distribute resources in Myanmar, as are discussions with other health programs, because the same Xpert machine can be used for HIV viral load, hepatitis C diagnosis and monitoring, human papillomavirus testing and tuberculosis testing and monitoring. As resources, workforce and space are all limiting factors for the provision of care in Myanmar, bringing these programs together and using a hub-and-spoke model for sending samples from sites with low caseload to sites with high caseload where the POC machine is located [ 27 ] may add efficiencies to the system in terms of optimising machine use, technical expertise, maintenance and infrastructure support. This will require utilization of the Xpert machine with modules appropriate for the caseload of the health facility in order to avoid delays in result communication.…”

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

“…All studies were conducted in sub-Saharan Africa except for one study from Thailand [38]. Nine cost analyses included primary cost data collection [39][40][41][42][43][44][45][46][47]. Cost estimates for other studies were derived from programmatic data, published estimates (e.g., Clinton Health Access Initiative, Global Fund [48,49]), or the literature.…”

Filtration-assisted magnetofluidic cartridge platform for HIV RNA detection from blood

“…Both the Abbott m-PIMA and Cepheid GeneXpert platforms for testing HIV are marketed for use at the point-of-care, however each instrument costs $25 000 and $17 500 respectively and each test for assessing viral load (>$25 each) requires trained operators to conduct plasma separation by centrifugation. 8…”