Evaluation of the Mean Cost and Activity Based Cost in the Diagnosis of Pulmonary Tuberculosis in the Laboratory Routine of a High-Complexity Hospital in Brazil

Abstract

At a global level, with the increase in healthcare costs, there is a need to assess the economic impact of the incorporation of new technologies in different health disorders in different countries. There is scarce information regarding costs incurred with the use of current or new diagnostic tests for tuberculosis or from the vantage point of their incorporation within the healthcare systems of high-burden countries. The present study aimed to assess the mean cost and the activity based cost of the laboratory diagnosis for tuberculosis by means of conventional techniques and from the Detect TB®LabTest molecular test kit in a general high-complexity hospital of the public health system in Brazil. Cost analysis was performed by means of primary data, collected in the Mycobacteria and Molecular Biology Laboratory in 2013. The mean cost and activity based cost were, respectively, U$10.06/U$5.61 for centrifuged bacilloscopy by Ziehl Neelsen (ZN) and Auramine (AU); U$7.42/U$4.15 for direct bacilloscopy by ZN; U$27.38/U$16.50 for culture in a Loweinstein-Jensen solid medium; and U$115.74/U$73.46 for the Detect TB®LabTest Kit. The calculation of the ABC should be used in making decisions by administrators to be the best method of assessing the costs of conventional techniques and molecular method for providing the real value of the tests. So it is need to calculate the ABC, and not of the mean cost, in various scenarios before incorporating new technologies in health institutions.

Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital

“…The ABC of the LJ culture (US$ 5.27) was less than that reported by the Brazilian Health Ministry (US$ 9.59) 15 , in India (US$ 9.83) 21 , the cost reported in studies conducted by Almeida et al 2017 (US$ 16.50), or in Africa, where there was a variation from US$ 12.16 to US$ 28.00 4,23,24 . These differences may be due to the use of different inputs, such as decontaminating agents and procedures, or the number of tubes used.…”

“…It should also be noted that ABC better reflects the reality of the cost analysis, as it provides the real value of the tests, as well as the importance of conducting cost studies based on data that has been duly computed, and not merely estimated based on other studies or the prices set by the Brazilian Health System 15,20 .…”

“…In South Africa, the ABC of the bacilloscopy was US$ 2.25, compared to US$ 2.38 in England 4,5 and US$ 0.83 in India 21 . Among the series described in Brazil, another study found the ABC to be US$ 4.72 (Centrifuged Bacilloscopy) and US$ 4.15 (Direct Bacilloscopy) 15 . These differences could be due to the different methods used to calculate the cost, the characteristics of the organization, or the operation of the laboratories where the study was carried out.…”

“…In Brazil, a recent study attempted to provide subsidies for managers in order to identify their primary cost guidelines, as well as possible gains in efficiency and effectiveness, when adopting Xpert ® MTB/ RIF after implementing ABC methodology 14 . Another study assessed the mean cost and ABC of TB laboratory diagnoses by means of conventional techniques and the DetectTB ® LabTest molecular kit in a high-complexity general hospital in a public health system 15 .…”

Global TB Network: working together to eliminate tuberculosis

“…In addition, one of the best examples is the Brazilian Rede TB , which shows that the best research efforts, even in a large country as is Brazil, can collaborate to solve country-specific priorities and involve national tuberculosis programs and authorities in the plan. 7 - 11 However, as of today, no global tuberculosis network is operational enough to put together all of the abovementioned actors in order to support the fight against tuberculosis.…”