Evaluating the Economic and Health Impacts of Investing in Laboratories in East Africa
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World Bank, Washington, DC
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Laboratories provide essential services
to the health sector on the monitoring and treatment of
disease. Routine implementation of new diagnostic techniques
may be costly; therefore, understanding their clinical
utility, impact, and cost-effectiveness are necessary to
guide decisions as to whether and how such techniques should
be implemented. In this study, the authors design a
conceptual framework for examining the following: (1)
optimal mix of laboratory services at different levels of
the health system; (2) combination of resources required
within laboratories to promote efficiency; and (3) potential
for outsourcing to promote cost containment. The framework
considers both the health and economic rationale for
laboratory investments. The authors then use the conceptual
framework to inform a decision analytics model that maps out
the health and economic impact of laboratory investments,
and to illustrate the model by investigating the best
placement of a new technology (GeneXpert) for detecting
multi-drug-resistant tuberculosis (MDR-TB). The illustrative
application of the model shows that investment in a new
diagnostic technology for MDR-TB is cost-effective
regardless of placement in a district-level (satellite) or
national-level (reference) laboratory. Placement of the
GeneXpert system at the satellite laboratory results in
patients tested for MDR-TB or TB at lower costs than the
reference laboratory. Furthermore, if testing occurs at the
satellite laboratory, more primary and secondary cases are
treated and cured than if testing was conducted at the
reference laboratory, leading to better outcomes. Overall,
testing at the satellite laboratory results in more deaths
averted and more disability life-adjusted years (DALYs)
saved. Both facilities have average costs per DALY well
below the World Health Organization (WHO) - suggested
threshold for the per capita gross domestic product (GDP).
However, the satellite laboratory saves more DALYs at a
lower additional cost per DALY.
Palabras clave
PHARMACY, CLINICAL CHEMISTRY, HARMONIZATION, RISKS, HUMAN CAPACITY, TREATMENT, DIAGNOSIS, SUPERVISION, EQUIPMENT, LABORATORY TESTING, EPIDEMIOLOGICAL DATA, LUNG DISEASES, SYNDROMES, INFORMATION SYSTEM, HUMAN IMMUNODEFICIENCY VIRUS, ANTIMALARIAL DRUGS, PREVENTION, DISEASE BURDEN, DISEASE PREVALENCE, MORBIDITY, SEXUALLY TRANSMITTED DISEASES, COMMUNITY HEALTH, INFORMATION, MONITORING, DISEASE TRANSMISSION, HEALTH CARE, BIOCHEMISTRY, DEATH, PREVALENCE, EFFECTS, CLINICAL OUTCOMES, HEALTH, TRANSMISSION, DISEASE PREVENTION AND CONTROL, HIV # POSITIVE, DISEASE REPORTING, LABORATORY SERVICES, DRUG RESISTANCE, TB CONTROL, INFORMATION SYSTEMS, PUBLIC HEALTH, LIFE EXPECTANCY, SATELLITE, LEPROSY, DATA, PATHOGENS, DISEASES, INFECTIOUS DISEASES, PATIENTS, PATIENT, LIFE, DNA, INTERVENTION, HIV/AIDS CARE, SEROLOGY, PRODUCTIVITY, OPPORTUNISTIC INFECTIONS, HEALTH MANAGEMENT, HIV INFECTION, MEDICAL CARE, STANDARDIZATION, DURATION OF TREATMENT, TUBERCULOSIS CONTROL, DIAGNOSTIC METHODS, MATERIAL, TUBERCULOSIS, SYMPTOMS, SCREENING, HIV/AIDS, EPIDEMICS, INVENTORY, DISEASE PREVENTION, MORTALITY, CAPABILITIES, MALARIA DIAGNOSIS, MEDICAL TREATMENT, DANGEROUS DISEASES, DISEASE OUTBREAKS, IMMUNE DEFICIENCY, TECHNOLOGY, BLOOD SAMPLES, DIAGNOSES, RELIABILITY, HEMATOLOGY, MEDICAL RESEARCH, WORKERS, HIV ANTIBODIES, TIME FRAME, HIV, TB, RESULTS, SURVEILLANCE, IMMUNODEFICIENCY, HEALTH POLICY, MEDICINE, HEALTH OUTCOMES, NETWORKS, FAX, DECISION MAKING, MEASUREMENT, NUTRITION, MEDICAL OFFICER, MALARIA, ADOLESCENTS, QUALITY CONTROL, HEALTH SURVEILLANCE, BURDEN OF DISEASE, THERAPY, DIAGNOSTICS, INTERNET, RESULT, COMMUNICABLE DISEASES, PATHOLOGY, VIRUS, TROPICAL MEDICINE, PHYSICAL HEALTH, DISEASE CONTROL, DISEASE, CLINICS, NETWORK, HUMAN RESOURCES, RETENTION, INFECTION, DISABILITY, INFECTIONS, ALL, SITES, EARLY DETECTION, COMMUNICATION, NEW TECHNOLOGY, STRATEGY, EPIDEMIOLOGY, DISEASE CHARACTERISTICS, CLINICAL BIOCHEMISTRY, MEDICINES, TECHNOLOGIES, AIDS, OUTSOURCING, HEALTH SERVICES, IMPLEMENTATION, LUNG DISEASE, USES, DISEASE DETECTION, STORAGE