The Economics of Point of Care Testing - Essay Example

THE ECONOMICS OF POCT Introduction Point of Care Testing (POCT) aims at providing testing that is timely and more effective to the patient (1) but over time, there have been controversies as to whether POCT is more cost effective as compared to clinical laboratory tests or not. But generally when the two are compared, POCT seeks to use simple test devices that may be small bench analyzers or single use devices for tests such as blood glucose and urine. In POCT, the tests do not have to be done by a laboratory technician like in a clinical laboratory; the patients themselves and other medical personnel often carry out the tests. This study seeks to establish the actual cost of POCT for HbA1c & Haemoglobin. HbAIc is a test carried out on diabetic patients for monitoring purposes. According to WHO, about 177 million people were affected by Diabetes in 2000 and the prevalence was expected to rise to more than 370 million in 2030 (2). HbAIc use at POCT, as stated by Al-Ansary et al has been observed to present high interaction between the patient and the consultant as well as having better outcomes on the patients’ health (3). Lewis and Bradshow report in their article that blood analyzers are used to do full blood counts in clinical labs whereby the results take longer, require large volumes of blood and are more expensive but in POCT, simple devices such as the hemocue are used to carry out blood counts; they are easily portable, easy to use and simple as well as cheaper (8). This study aims at presenting the actual costs of two devices used in POCT tests of HbAIc and hemoglobin. The results will be compared with central laboratory costs for the same tests and conclusion will be drawn of the cost effectiveness of POCT in patient treatment and on-going management. The effect of variables such as volume of testing on the overall costs will also be checked and there will be recommendations for improvement of POCT costs ACTUAL COSTS-estimated- OF POCT FOR HB and HBAIc Figure 1: a table showing approximate costs of POCT using Hemocues and HBAIC devices per a patient in Australian Dollars Actual Costs-approximate- for 1200 individuals in AUSD/patient--Hemocues in AUSD/patient--HbAIC Capital Costs 4500 4000 Infrastructure Costs 100 100 Labor costs 3000 4000 Reagent costs 5 5 Calibration, QC and QA 40 40 Maintanance costs 30 30 Record keeping costs 10 10 Initial implement Costs 2500 3000 Training and assess costs 500 500 Acreditation and compliance costs 100 100 Total/patient 10785 11785 The table above shows estimated costs at POCT for Haemoglobin and HbAIc. The specific costs for HBAIc at POCT are adapted and modified from Laurence et al. whom recorder the actual costs for running a POCT center in 2006; the results were modified to reflect changes in costs of living and of acquiring items as at 2010-2011. For instance the labor costs as documented in Laurence et al total up to $3,700 as at 2006-including the actual HBAIc test, and costs incurred at the center such as pharmaceuticals, regular health visits, hospital admissions, special consultations, regular consultations and emergency visits (4p6). The figure has been inflated to $4,000 in the table above. The same trend was followed for the rest of the costs. Capital costs are costs that are required-in total-to set up and equip the center probably a mobile shelter, initial labor costs-recruitment and employment, reagents, devices (an hemocue for instance goes for $375), records, registration fee and other costs. Infrastructure costs include general operational costs such as transportation costs. Reagent costs are those incurred in purchase of reagents used during the tests such as methylated spirit. Calibration, QC and QA (quality assurance and quality control) are costs incurred to ensure the devices are in their expected initial functioning shape and that they produce necessary results and that the personnel conducting the tests are qualified as per the specified regulations. Maintenance costs may be split into two as general and specific maintenance expenses; general maintenance refer to costs incurred in day to day maintenance such as security and cleaning services, specific maintenance costs are incurred once in a while such as repair of the mobile shelter. Record keeping costs involve the costs incurred for storage of data-patients and other data such as references. Initial implementation costs are costs required for a POCT to be operational, at least before all infrastructures and equipment is in place. Training and assessment costs are those incurred in continuous upgrade of staff or costs incurred in training patients on how to use for instance self monitoring devices. Finally accreditation and compliance costs are those costs that are incurred in ensuring the whole center as a whole offers quality services. It is evident that requirements for POCT are fewer and less expensive as compared to a clinical laboratory and hence the initial capital costs are different. In a clinical laboratory for instance several tests are carried out and patients may be choosy based on the sophistication level of equipments and machines in place but this may never be the case with POCT especially when patients get to understand what they are and their benefits as compared to the clinical labs. THE INFLUENCE WHICH TESTING VOLUME MAY HAVE ON THE OVERALL COSTING It has been widely documented that patients being tested and receiving management at POCT happen to have better health outcomes in the sense that they are less hospitalized and make fewer medical visits as compared to those who are tested at clinical laboratories; the explanation behind this is that at POCT, there is early case management as a result of tests carried out on time and there is also efficient case management hence the patients’ fall ill less often and the volume of tests run on them is small. This has been observed to have an impact on the overall costing; Baer asserts that, many tests mean many equipment especially disposables, reagents and other supplies as well as direct test costs (5) - this makes POCT cheaper from a broad perspective. A comparative estimate of central laboratory costs for the same tests and justification for POCT costs POCT has many advantages over central/clinical laboratories that contribute to the cost benefits experienced when using the POCT services. First it brings the services as close as possible to the patient hence reducing transport costs and other costs that may come about during transportation to the health facility. Second as a result of easy access to services, the health problem is arrested early. For instance in diabetics who may have their sugar levels fluctuating rapidly and regularly, long distance travels to the hospital may have a negative impact; possibly the patient may die or better go on coma or have a different complication such as heart lapse; as such patients accessing POCT often spend less on hospitalization and medical visits than those who do not. Third, as a result of early tests, treatment and management, in overall the entire case management is cheaper; take an incidence of highly fluctuating blood glucose, when the patient take too long maybe on transportation they may fail to use resuscitating drugs or if the patient was on a drip that needed to be changes every after 1 hour, by the time they get to the hospital too many other tests will have to be run to ascertain the patient’s position (6), possibly many other conditions will need to be managed hence further expenses. Fourth, lesser time taken at POCT-less time on transport, less time waiting; a full blood count test take 24 hours for results to be released, lesser hospitalization and fewer hospital visits- ensure that the patient remains as productive as any other normal person hence is of value to developmental process. The cost efficiency with regard to patient treatment and on-going management Taking an example of diabetic patients a HbAIc test done in time ensure discovery and containment of an exploding condition by the right treatment and hence earlier management; as discussed above when the condition is let untamed various other conditions set in and managing the patient becomes difficult and very expensive. Petersen while analyzing works done by Gilmer, et al and Menzin, et al, observed that slight increases in HbAIc by even 1% lead to an increase in costs seven fold (7). Despite the fact that POCT is generally observed to be cheaper, results have discovered otherwise; A study by Al-Ansary et al, found out that apart from the reduced hospital visits costs, clinical laboratory methods are on overall cheaper (3). There has been a controversy on the accuracy and reliability of tests performed at POCT such as the hemoglobin test versus the full blood count done at a clinical laboratory; it is evident that some tests done at POCT may overlook some issues for instance HB by hemocue or hemoglobin color scale may not expose that the patient is at risk of anemia since the HB levels will be counted as normal. But blood counts on the other hand show several pre-disposing conditions to anemia and other blood-originating disease conditions (8). As such the cost efficiency of POCT test is questioned since one may end up developing anemia hence high maintenance costs. Generally POCT becomes cheaper because it targets the disease at its primary stages hence less treatment and management costs but raw costs put together may be higher than those at clinical lab, but in clinical laboratory due to the complex procedures, many tests generally raise the cost. Therefore in conclusion POCT may be cheaper given the early and longer health outcomes. Suggestions for cost recovery, cross subsidization, patient or Medicare billing Now that the two methods seem closely related in terms of costs there is need to ensure the methods stand out separately. First there may be need to subsidize the cost of clinical tests further such that in their complexity and sophistication, patients can still enjoy timely and cost effective services; the government can for instance collaborate with some private stakeholders to probably offer POCT services as an extended arm of clinical lab services such that a test like HB can be done quickly for faster remedies as POCT then the blood sample could be analyzed further if need be at a clinical lab for subsidized costs and not as separate bills. Secondly, the government can improve access to healthcare by ensuring there is a health facility within a certain proximity hence making services easily available even from clinic level. Thirdly, the government in collaboration with other stakeholders can ensure the way medical billings are done and insurance systems, ensure faster payments to the users that before-for instance introducing automated systems of cashing billings in less than 24 hours; of course the Australian government is making positive efforts towards this direction (9). The use of mobile technologies can also be embraced to take computed services for instance close to people with regard to disease management to avoid the pressing need to attend clinical labs for such services. In conclusion POCT is a more economical method since its advantages are many as compared to clinical lab method; what matters at the end of the day is good health quickly and not good health after a long period of struggles with various episode. More emphasis should be laid towards advancing the strategy; the medical field should take advantage of advancing technology to ensure services are as close to the patients as possible. References 1. Price, P. Christopher. Point of Care Testing. BMJ. 2001 May 26; 322 (7297): 1285. 2. World Health Organization. Global Strategy on Diet, Physical Activity and Health: Diabetes [internet]. 2004 [Cited 2011 May, 13]. Retrieved from http://www.who.int/hpr/gs.fs.diabetes.shtml. 3. Al-Ansary L, Farmer A, Hirst J, Roberts N, Glasziou P, Perera R, Price PC. Point-of-Care Testing for Hb A1c in the Management of Diabetes: A Systematic Review and Metaanalysis. Clinical Chemistry. 2011 March 2; 57: 568-576 4. Laurence, O. Caroline. The Cost-Effectiveness of Point of Care Testing in a general Practice Setting: Results from a randomized controlled trial. BMC Health Services Research. 2010. 10:165. Print 5. Baer, M. Daniel. Point-of-care testing versus central lab costs. The CBS Interactive Business Network [Internet]. 2010. [Cited 2011 May, 13]. Retrieved from findarticles.com/p/articles/mi_m3230/is.../ai_21188204/ 6. Roche Diagnostics. Point of Care Glucose: Advantages of connectivity [Internet]. 2005. [Cited 2011 May, 12]. Retrieved from www.poc.roche.com/en_US/.../POC_Connectivity_White_Paper.pdf 7. Petersen, R. John. Impact of POCT HbAIC on the maintenance of Glycemic Control in a diabetic population [Internet]. [Cited 2011 May, 13]. Retrieved from http://www.aacc.org/SiteCollectionDocuments/Divisions/cpoct/presentations/Refining/Refining_Petersen.pdf 8. Lewis MS, Osei-Bimpong A, Bradshaw A. Measurement of Hemoglobin as a screening Test in General Practice. Journal of Medical Screening. 2004; 11(2). 9. Australian Government. Medicare Easyclaim for health professionals [internet]. [2011]. [Updated 2011 May, 9; Cited 2011 May 13]. Retrieved from http://www.medicareaustralia.gov.au/provider/medicare/claiming/easyclaim/index.jsp Read More