Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Elsbernd, Kira; Emmert-Fees, Karl M. F.; Erbe, Amanda; Ottobrino, Veronica; Kroidl, Arne; Bärnighausen, Till; Geisler, Benjamin P.; Kohler, Stefan

doi:10.1186/s40249-022-01006-7

Infectious Diseases of Poverty

Table 1 Unit cost per test for HIV early infant diagnosis

From: Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Test	Reported unit cost (USD) per test (range)	Currency of reported unit cost	Converted (USD 2021) unit cost per test	Services included in the unit cost	Setting	Source of cost data	Source(s)
PoC nucleic acid testing
m-PIMA	25 (23–27)	2018 USD	26.82 (24.68–28.97)	Reagents, sample collection, labor	sub-Saharan African countries	CHAI	Salvatore et al. [50]
m-PIMA (reagent rental model^a)	25.89	2017 USD	28.44	Reagents, blood collection, freight (insurance and customs clearance), training, facility upgrades, site monitoring, labor, error rate^b	Zimbabwe	Financial records and other secondary sources	Mukherjee et al. [40]
m-PIMA	44.55	2017 USD	48.94	Platform and warranty purchase, reagents, blood collection, freight (insurance and customs clearance), storage and distribution, training, facility upgrades, site monitoring, labor, error rate^b	Zimbabwe	Financial records and other secondary sources	Mukherjee et al. [40]
m-PIMA	48.28	2018 USD	51.80	Platform purchase and install, maintenance, freight, and distribution; reagents, blood collection, waste management, labor	Zambia	NSEBA study, CHAI	De Broucker et al. [53]
m-PIMA or GeneXpert IV	27.24 (21.39–33.10) optimal throughput 37.89 (32.54–43.25) current throughput^b	USD, year not specified	29.93 (23.50–36.36) 40.65 (34.91–46.41)	Reagents, controls, and other consumables, and apportioned costs of equipment, logistics, training, service, and maintenance	Cameroon, Côte d’Ivoire, Kenya, Lesotho, Mozambique, Rwanda, Swaziland, and Zimbabwe	The Global Fund	Bianchi et al. [13]
GeneXpert IV & GeneXpert Edge	20 (18–22)	2018 USD	21.46 (19.31–23.61)	Reagents, sample collection, waste management, labor	sub-Saharan African countries	CHAI	Salvatore et al. [50]
GeneXpert IV (no equipment costs)	23.85	2017 USD	26.20	Reagents, sample collection, waste management, freight (insurance and customs clearance), storage and distribution, training, facility upgrades, site monitoring, labor, error rate	Zimbabwe	Financial records and other secondary sources	Mukherjee et al. [40]
GeneXpert IV Gel	27.27		29.96	Same as above + platform and warranty purchase, gel battery^b
GeneXpert IV Solar	27.70		30.43	Same as above + platform and warranty purchase, solar battery^b
GeneXpert IV Gel	30.71	2017 USD	33.74	Same as Mukherjee 2020 GeneXpert IV Gel	Zimbabwe	Mukherjee 2020	McCann et al. [51]
GeneXpert	27.91	2018 USD	29.95	Platform purchase and install, maintenance, freight, and distribution; reagents, blood collection, waste management, labor	Zambia	NSEBA study, CHAI	De Broucker et al. [53]
Unspecified PoC EID assay	27.61	2016 USD	30.91	Reagents, controls, and other consumables, and apportioned costs of equipment, logistics, training, service, and maintenance	Zimbabwe	The Global Fund	Frank et al. [52]
Unspecified PoC EID assay	30	2013 USD	34.90	Not specified	South Africa	Assumption	Dunning et al. [54]
Laboratory-based nucleic acid testing
Roche COBAS Ampliprep®/TaqMan®	15.11	2018 USD	16.21	Reagents, sample collection, transport, waste management, labor	sub-Saharan Africa	CHAI	Salvatore et al. [50]
Abbott m2000	17.41	2018 USD	18.68		sub-Saharan Africa	CHAI	Salvatore et al. [50]
Laboratory-based NAT (LAB)	18.10	2017 USD	19.89	Not specified	Zimbabwe	Nichols 2019	McCann et al. [51]
Strengthened laboratory-based NAT (S-LAB)	30.47	2017 USD	33.48	Same as above + daily sample transport, EID-specialized personnel, additional training	Zimbabwe	EGPAF programmatic data	McCann et al. [51]
Roche Amplicor HIV-1 DNA PCR	21.50	USD, year not specified	26.46	Insurance, freight and tax charges, filter paper, reagents, courier service, labor	Kenya	Not listed	Khamadi et al. [39]
Unspecified laboratory-based NAT	25	2013 USD	29.08	Not specified	South Africa	NHLS South Africa—personal communication	Dunning et al. [54]
Unspecified laboratory-based NAT	25	2013 USD	29.08	Assays, reagents, personnel time for counseling, blood collection, specimen transport and processing, quality control	South Africa	Assumption	Franke et al. [24]
Roche Amplicor HIV-1 DNA rtPCR v1.5	23.32–23.76	2007 USD	29.80–30.36	Equipment, assay, sample collection, labor	Uganda	Data collected during study	Menzies et al. [41]
Unspecified laboratory-based NAT	27.61	2016 USD	30.91	Reagents, controls, and other consumables, and apportioned costs of equipment, logistics, training, service, and maintenance	Zimbabwe	The Global Fund	Frank et al. [52]
Unspecified DNA-rtPCR	32.40	2017 USD	35.60	Not specified	Tanzania	Hospital data	Vyas et al. [46]
Roche COBAS Ampliprep®/TaqMan®	38.07	2018 USD	40.85	Platform purchase and install, maintenance, freight, and distribution^b; reagents, blood collection, waste management, labor	Zambia	NSEBA study, CHAI	De Broucker et al. [53]
Roche or Abbott conventional rtPCR	38.89 (28.57–49.21) result within 3 months 131.02 (96.26–165.76) result within 30 days	USD, year not specified	42.73 (31.39–54.06) 143.94 (105.75–182.11)	Reagents, controls, and other consumables, and apportioned costs of equipment, logistics, training, service, and maintenance	Cameroon, Côte d’Ivoire, Kenya, Lesotho, Mozambique, Rwanda, Swaziland, and Zimbabwe	The Global Fund	Bianchi et al. [13]
Unspecified laboratory-based NAT	40.50	2016 USD	45.34	Sample collection, counseling, transport, laboratory test costs	Lesotho	Study data	Tchuenche et al. [44]
Proviral DNA rtPCR in-house assay from DBS	8–10	USD, year not specified	9.05–11.31	Filter paper, reagents, equipment maintenance, human resources	Angola	Data collected during study	Martin et al. [55]
DNA rtPCR in-house assay from DBS	57.14	2011 USD	68.90	Equipment, reagents, blood collection, transport, labor, maintenance	Thailand	Sirirungsi (2013); Clinton Foundation (2009)	Collins et al. [38]
Rapid HIV test
PoC p24 antigen detection test	< 15 per assay	USD, year not specified	15.82	Not specified	Zambia	Study data	Sutcliffe et al. [56]
Initial Rapid RHT + confirmatory PCR for positive infants	7.58–22.75^c	2007 USD	9.68–29.07	Assay, sample collection, labor	Uganda	Study data	Menzies et al. [41]
Unspecified NAT
NAT per local EID programs	24	2018 USD	25.75	Not specified	Cote d'Ivoire, South Africa, Zimbabwe	The Global Fund	Dunning et al. [57]

USD United States dollar, PoC point-of-care, CHAI Clinton Health Access Initiative, EID early infant diagnosis, rtPCR reverse transcriptase polymerase chain reaction, DBS dried blood sample, NAT nucleic acid testing
^aConsolidated cost for testing cartridges inclusive of equipment, maintenance, data, and connectivity, assuming 1300 tests/platform/year and including VL assays, over 3 years
^bIncorporates utilization (i.e., the ability of the machine to run additional assays including HIV viral load for mPIMA and HIV viral load and tuberculosis for GeneXpert®)
^cRange dependent on infant age and symptoms. Cost includes RHT + confirmatory DNA-PCR if RHT is positive. Rapid RHT activity cost is 0.88 USD

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ISSN: 2049-9957

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