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Working Paper

Evaluating the Economic and Health Impacts of Investing in Laboratories in East Africa : Development and Application of a Conceptual Framework

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
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World Bank, Washington, DC
Africa | East Africa
2015-06-24T19:24:11Z | 2015-06-24T19:24:11Z | 2015-05

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.

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