 Evaluating the Economic and Health Impacts of Investing in Laboratories in East Africa: Development and Application of a Conceptual FrameworkSimone Peart Boyce, Andrés A. Berruti, Helen Connolly and Miriam Schneidman No 97386, Health, Nutrition and Population (HNP) Discussion Paper Series from The World Bank Abstract: 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. Keywords: pharmacy; clinical chemistry; harmonization; risks; human capacity; treatment; diagnosis; supervision; equipment; laboratory testing; epidemiological data; lung diseases ... See More + 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 (search for similar items in EconPapers) Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:wbk:hnpdps:97386 Access Statistics for this paper More papers in Health, Nutrition and Population (HNP) Discussion Paper Series from The World Bank 1818 H Street, N.W., Washington, DC 20433. Contact information at EDIRC. |
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