Micro-costing analysis of integrating SARS-CoV-2 antigen rapid detection tests into routine health facility services: a comparison of test-all versus screen-and-test models in Cameroon and Kenya.

INTRODUCTION

Understanding costs associated with identification of emerging infections is critical to inform the policy. Nested within a randomised controlled trial that found that a test-all (TA) model for rapid SARS-CoV-2 testing identified more SARS-CoV-2 cases than the standard screen-and-test (ST) model. Our study assessed the cost-effectiveness of integrating SARS-CoV-2 services into maternal, neonatal and child health (MNCH), HIV and tuberculosis (TB) clinics using the two models in Cameroon and Kenya.

METHODS

The total costs of implementing the TA and ST models in Cameroon and Kenya were estimated from a health systems perspective using a micro-costing method. The cost per client tested (CPCT) and tested positive (CPCTP) for SARS-CoV-2 were estimated by dividing the total cost of each model by the number of clients tested and tested positive, respectively. A decision tree and cost-effectiveness acceptability curve were used to compare the cost-effectiveness of the two models.

RESULTS

In Cameroon, the total cost of the TA model was US$141,942, while the ST model was US$48,020. In the TA model, the CPCT was US$7.66 and the CPCTP was US$508.75, whereas in the ST model, they were US$25.02 and US$727.58, respectively. In the TA model, the biggest cost was SARS-CoV-2 antigen rapid detection tests (Ag-RDTs) at 61% (US$86,853), whereas in the ST model, it was personnel at 39% (US$18,592). In Kenya, the total cost was US$39,264 in the TA model and US$27,500 in the ST model. The TA CPCT was US$13.04 and the CPCTP was US$1,189.81, whereas in the ST model the costs were $125.00 and $1,250.01 respectively. In both models in Kenya, the biggest expenditure was personnel, at 45% ($17,696) of cost in TA and 56% ($15,267) in ST. In both countries, the TA model was more cost-effective.

CONCLUSIONS

Implementation of the TA model is a more cost-effective approach to increase early identification of individuals with SARS-CoV-2 infection.