Economic analysis of FIND MGIT demonstration project * Samara ...

Economic analysis of FIND
MGIT demonstration
project
* Samara, Russia
* Manila, Philippines
Hojoon Sohn, MPH
Foundation for Innovative New Diagnostics

Goals of Economic Analysis Study
COST
Assessment of True
Laboratory Costs:
Infrastructural Costs
Assessment of True
Laboratory Costs:
Variable Costs (time sensitive)
Compare Costs between
MGIT and LJ or Ogawa
EFFECTIVENESS
MGIT Laboratory
Efficiency
in Project Laboratories
Improved TB/MDR TB
Detection
Impact of MGIT:
Reporting of results and
Initiation of treatment
ANALYSIS
Evaluate Feasibility of
Implementing MGIT

Types of “Cost” considered in the study
Monetary or Financial Cost -expenses incurred for an input or to provide a product or
service, at a given time (e.g. prices paid for medical supplies, price charged for a clinical service)
Economic or Opportunity Cost -the value of benefits forgone by using resources to
provide alternate products or services (e.g. the value of providing MGIT test vs. LJ or solid media test for culture diagnosis of
TB)
“Accounting” Cost - cost applied to reflect the real value of a product or service at a given time; the
cost is not actually incurred (e.g. depreciation allowance for medical equipment)
“Shadow” Prices -costs applied to goods and services whose true value is not the same as listed (e.g.
value of donated equipment, the time of volunteer staff)
Direct vs. Indirect Cost-Direct costs (supplies, labor costs, pharmaceuticals), Indirect costs
(overhead costs, utilities, salaries of all staff involved with the laboratory)
Unit and Average Cost-the cost of producing one unit of a good or service (averaged for average
cost from total cost)
Incremental Cost-the amount of additional resources needed to implement the larger program

Cost analysis pathway for laboratory diagnostic
systems
Types of data relating to cost
of diagnostic procedure
Resource/
Equipment Prices
Life expectancy of
equipment
Annual equipment
maintenance cost
Cost of Labor
operational costs
(ex. Utilities)
Amount use of
resources
•Building
•Equipment
•Staff
•Medical Supplies
•Other Lab
Supplies
Variable (time) costs
Variable (consumables) costs
Fixed (Overhead) costs
Training costs
Specimen
transportation costs
•Total Cost = Fixed Cost + Variable Cost
# specimen observed/processed
Average (unit) cost

Laboratory cost estimation tool
(LCET)
Simple - Data collection is done on prepared excel worksheets;
computerized data for both PC and MAC
Data can be collected in one site visit (training for self-collection)
Results are automatically calculated
Results can be presented in many ways - to help understand
advantages and disadvantages of MGIT compared to other available
diagnostic methods by manipulating calculation scheme; relatively easy
manipulation in excel
Simple collection version for self data collection by laboratory staff is
available and is relatively easy provided with a brief user’s manual;
enables multiple collection of data without requiring site visit

data collection criteria
Review all of the resources listed for each worksheet (each
worksheet represents distinct steps in TB diagnosis via culture for
solid and liquid culture method).
Report number of specimen observed/processed for each procedure
(ex. Decontamination/Media Prep, etc.)
Review corresponding unit measurements of each resources If unit
measurements are expressed in time (minutes), report utilization
time of applicable resource (more in detail)
Complete the worksheet for each procedure

Continued...
Ideally, one person would observe another person performing
specific laboratory tasks (ex. Decontamination)
Each procedures listed on LCET must be observed at least once for
data collection and repeat measurement may be necessary to observe
potential variation of data based on “sample” size
Follow general laboratory schedule and DO NOT alter your schedule
for data collection
Depending on the type of TB diagnostic work performed at each lab,
one full set of data can be collected in one to two weeks

Preliminary results:
Cost Analysis - DST First line drugs, SIRE
EXPRESSED AS AVERAGE COST PER SPECIMEN,
USD
TROPICAL DISEASE FOUNDATION, MANILA, PHILIPPINES
Test Decontamination Prep LJ MDLB Prep LJ MGIT Total LJ Total MGIT
International
2006
4.37 0.19 1.68 22.47 43 28.72 47.38
Local 4.18 0.14 1.34 21.21 26.46 26.86 30.64
% difference 6.45% 35.33%
Клинико-диагностическая и бактериологическая лаборатория, Samara, Russia
Test Decontamination Prep LJ LJ MGIT Total LJ Total MGIT
International
2006
3.32 1.08 15.46 39.12 19.87 42.44
Local 2.76 0.49 14.12 22.53 17.36 25.29
% difference 12.62% 40.41%

cost by category
Samara, Russia
Figure I. DST Cost By Input (LJ vs. MGIT), International Prices 2
50.00
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
Medical supplies
Staff
Equipment
Building
Overhead
MGIT’S MAIN COST CONCERN IS
CONSUMABLES COST
0.00
LJ
MGIT
Figure II. DSTCost By Input (LJ vs MGIT), Local Prices, 20
25.00
20.00
LJ’S MAIN COST CONCERNS ARE
OVERHEAD AND LABOR COSTS
15.00
10.00
5.00
Medical supplies
Staff
Equipment
Building
Overhead
0.00
LJ
MGIT

cost by category
Manila, Philippines
Figure I. DST Cost By Input (LJ vs. MGIT), International Prices 2
50.00
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
Medical supplies
Staff
Equipment
Building
Overhead
5.00
0.00
LJ
MGIT
Figure II. DSTCost By Input (LJ vs MGIT), Local Prices, 20
SIMILAR TREND
30.00
25.00
20.00
15.00
10.00
Medical supplies
Staff
Equipment
Building
Overhead
5.00
0.00
LJ
MGIT

Isoniazid & Rifampicin Testing
Samara, Russia
INTERNATIONAL 2006, USD
Decontamination Prep LJ Total
Test Ohead Building Equipment Staff Consumables
LJ 3.74 0.78 5.97 1.18 1.35 2.02 0.35 15.38
MGIT 3.74 N/A 4.01 0.90 3.25 0.96 14.97 27.82
LOCAL 2006, USD
Decontamination Prep LJ Total
Test Ohead Building Equipment Staff Consumables
LJ 3.17 0.42 5.97 1.18 0.66 2.02 0.58 14.01
MGIT 3.17 N/A 4.01 0.9 1.65 0.96 7.76 18.45

Concern: detection vs. identification
bacteriologist and microbiologist agree that detection
does not equal to identification
fore-mentioned cost does not include identification
cost of identification is added cost and is assessed as an
independent procedure
currently available cost information on identification:
SPECIES IDENTIFICATION VIA BIOCHEMICAL METHOD

Cost of species Identification - Biochemical Assay
Manila, Philippines
INCLUDED PROCEDURES:
Cost Category
Cost per specimen
colony identification
semi-quantitative catalase test
growth rate test
nitrate reduction test
68 C catalase test
Niacin test
Overhead 3.39
Building 0.003
Equipment 1.18
Staff 0.82
Medical Supplies + Other
Lab supplies 2.71
Total 8.13

Cost: Russia Vs. Philippines
Initial difference in cost per specimen was due to:
1) PRICE DIFFERENCE IN CONSUMABLES AND LABORATORY EQUIPMENTS
2) COST OF LABOR
3) DIFFERENCES IN DIAGNOSTIC SCHEME
4) TYPES OF SOLID MEDIA PERFORMED FOR DST - LJ VS. MIDDLEBROOK
5) COST OF “SPACE”

Preliminary Conclusion
MGIT DST, when evaluated at FIND-BD price (2 for 1) shows
very promising potential for cost effectiveness - particularly due to
the fact that significant cost of MGIT pertains to medical/pharmaceutical supplies costs
Case-finding costs for MGIT is indifferent from Solid Media
costs but are subject to inclusion of cost of identification
Rapid DST costs - IR testing also presents very promising
potential for cost effectiveness for MGIT
Proper cost effectiveness study should be conducted to
properly assess “cost effectiveness” of MGIT over solid
media culture

Challenges -
Data collection
Difficulties in obtaining “accurate” information on cost of
“space”
difficulties in obtaining cost of overhead (information is
distributed amongst many different “departments” within the laboratory organization and
many of items are reported as consolidated cost to the entire organization (or hospital if the
lab is located within a large hospital building)
unifying analysis consumables and equipment prices in
same dollar years (2006)
implementing data collection (variable cost) infrastructure
- now there is a much improved version available and is being used in a project in Thailand

Benefit of “Self” Data Collection by
Lab staff
Cost assessment method and concept are consistent
regardless of type of lab diagnostic system and disease
category
Establish data collection infrastructure for future cost
assessment of newer innovative laboratory diagnostic
systems
much simpler version of “self” data collection worksheet
AND DETAILED USER’S MANUAL ARE now available for rapid
and accurate data collection
Goal - standardize laboratory diagnostic system cost
assessment

Ideas for future studies
Standardizing evaluating laboratory diagnostic costs -
concepts employed are consistent regardless of systems
and disease category -
need for standardized manual and data collection
worksheets
cost effectiveness study for MGIT vs. solid media culture -
currently there is a study in progress in Thailand involving 6
laboratories (incl. NTRL)
Inclusion of cost of identification (capilia, biochemical
assay, Hain, Microarray, etc.)
cost of smear as part of culture diagnosis
+ 2nd line drug testing cost (for XDR-TB)

THANK YOU