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Life sciences · Journal article
The Lancet. Microbe
A consensus or society position rather than new primary data.
This costing study provides consensus-informed estimates of capital and consumable costs for establishing and operating minimal clinical bacteriology laboratories in sub-Saharan African hospitals. The estimated consumable cost per hospital admission ranges from $6.23 to $10.86 USD (2023), with initial equipment cost around $30,763, but costs from regional suppliers may be substantially higher. The evidence is moderate-strength guidance suitable for national planning rather than a comparative effectiveness finding.
Costing model informed by expert consensus and real-world laboratory data. Secondary and tertiary care hospitals in sub-Saharan Africa; expert panel representing academia, funders, and implementers from Africa, North America, and Europe; data informed by two accredited bacteriology laboratories in Benin and Ethiopia. Intervention: Minimal list of equipment and consumables for implementing clinical bacteriology laboratory for bloodstream infection diagnosis. Compared with: Strict minimum scenario versus standard scenario; international supplier costs versus estimated national distributor costs in sub-Saharan Africa. Expert consensus assembled from Africa, North America, and Europe; empirical data from laboratories in Benin and Ethiopia; supplier quotes from North America and Europe.
Mean consumable cost per hospital admission $6.23 (95% uncertainty range 5.42–7.54) in strict minimum scenario Mean consumable cost per hospital admission $10.86 (9.82–12.31) in standard scenario Mean cost of minimal equipment list at laboratory establishment $30,763 (28,403–33,043) with annual maintenance $3,076 (2,840–3,304)
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Health administrators, funders, and policy makers in sub-Saharan Africa can use these estimates to benchmark and plan procurement budgets for implementing clinical bacteriology capacity. Clinicians and laboratory professionals should note that actual regional costs may exceed these international supplier quotes substantially, requiring local adaptation of minimal equipment lists.
A costing model informed by expert consensus and real-world data from two African laboratories, providing evidence-based cost estimates and procurement guidance for implementing clinical bacteriology in resource-limited settings, without comparative effectiveness or outcome data.
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Health administrators, funders, and policy makers in sub-Saharan Africa can use these estimates to benchmark and plan procurement budgets for implementing clinical bacteriology capacity. Clinicians and laboratory professionals should note that actual regional costs may exceed these international supplier quotes substantially, requiring local adaptation of minimal equipment lists.
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Background. Inadequate access to clinical bacteriology testing in low-resource settings compromises individual patient care and contributes to antimicrobial resistance. Funders, policy makers, and health administrators working to expand bacteriology testing in sub-Saharan Africa require evidence-based guidance. The aim of this study was to assemble a costed consensus list of minimum equipment and consumables required to implement and operate a functional clinical bacteriology laboratory in secondary and tertiary care hospitals in sub-Saharan Africa, to guide funders and health administrators.Methods. A consensus list of minimum materials for diagnosing bloodstream infections was assembled by experts from Africa, North America, and Europe, representing academia, funders, and implementers. A modelling study was performed to estimate costs across several testing scenarios developed using a formal framework for forecasting testing volumes and reagent usage. Outcomes assessed were consumable costs per hospital admission and per investigation of septic episode and costs of non-recurring items at the time of establishment of a laboratory. Data from two accredited bacteriology laboratories providing individual patient care in Benin and Ethiopia were used to inform expected positivity rates, reagent usage, and testing volumes. Supplier quotes from North America and Europe were used to provide average unit costs and 95% uncertainty ranges.Findings. The estimated mean consumable cost per hospital admission was, in 2023 USD, $6·23 (95% uncertainty range 5·42-7·54) in the strict minimum scenario and $10·86 (9·82-12·31) in the standard scenario. The mean cost for the minimal equipment list at the time of establishment of a laboratory was estimated at $30 763 (28 403-33 043; plus an annual equipment maintenance cost of $3076 [2840-3304]), which includes purchase of commercial quality control strains and other non-recurring consumables. Available data suggest that costs from national distributors in sub-Saharan Africa could be three-fold higher than those described. Finally, we provide a transparent and adaptable basis for estimating minimal testing volumes and reagent usage, enabling tailored procurement planning in regions currently without clinical bacteriology laboratories.Interpretation. These results inform national antimicrobial resistance action plans on supply procurement, costing, and the ability to benchmark and forecast minimal acceptable testing volumes for the diagnosis of bloodstream infections for individual patient care.Funding. Fonds de recherche du Québec - Santé.
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