How much does point-of-care testing cost?

One of the reasons for using microfluidic technology is to shrink large machines down into portable desktop or handheld versions. A low cost per test is often important for point-of-care (POC) or point-of-use devices, especially when intended for resource-limited settings such as regions of Africa.

But how do you estimate the actual cost of a point-of-care test? Earlier this year, researchers from Boston University and the University of the Witwatersrand in South Africa published an interesting paper in PLoS ONE on “How to Estimate the Cost of Point-of-Care CD4 Testing in Program Settings: An Example Using the Alere Pima™ Analyzer in South Africa.”

The paper provides a starting point if you’re looking to estimate the costs per test in a similar setting. The authors break down the cost into six main areas for a total cost per test of ~$24 (table below).

Figure adapted from Larson B, Schnippel K, Ndibongo B, Long L, Fox MP, et al. (2012)  PLoS ONE 7(4): e35444. doi:10.1371/journal.pone.0035444

It turns out the Pima test is more expensive than conventional CD4 laboratory tests:

“…the average cost per CD4 test performed by the mobile HCT program using the Pima Analyzer was $23.76. In comparison, the fee for laboratory-based testing is around $7–8 per test.”

However early studies show the POC format may improve care due to the rapid turnaround time:

“One study from Mozambique reported a reduction in total loss to follow-up before initiation of antiretroviral treatment from 64% to 33%.”

It’s not clear whether additional factors such as biohazard waste disposal are included, or if things like this would contribute significantly to the cost. It’s encouraging that the authors feel POC testing has moved beyond validation to questions of cost and adoption, and it would be great to see more work on the cost implications of POC testing in places like Africa.

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