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. 2023 Jul 31;23(1):815.
doi: 10.1186/s12913-023-09775-z.

Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda

Donald S Shepard  1 , Yara A Halasa-Rappel  2   3 , Katharine R Rowlands  2 , Maria Kulchyckyj  2 , Robert K Basaza  4 , Emmanuel D Otieno  5 , Boniface Mutatina  6 , Simon Kariuki  7 , Sabine F Musange  8
Affiliations

Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda

Donald S Shepard et al. BMC Health Serv Res. .

Abstract

Background: We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019-2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing.

Methods: We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound).

Results: The ANC panel averted 92 (69-115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52-57) in Rwanda, and 258 (156-360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda.

Conclusion: Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.

Keywords: Antenatal care; Cost-effectiveness; HIV/AIDS; Hepatitis B; Kenya; Malaria; Rwanda; Syphilis; Uganda.

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Conflict of interest statement

All authors received funding from Abbott Rapid Diagnostics International Ltd. through an agreement with Brandeis University. The authors declare no other competing interests.

Figures

Fig. 1
Fig. 1
The ANC panel economic model flow chart Notes: ANC denotes antenatal care; ICER denotes incremental cost-effectiveness ratio; USD denotes United States dollars
Fig. 2
Fig. 2
Incremental cost-effectiveness ratio (ICER), $/DALY Notes: DALY denotes disability-adjusted life years; ICER denotes incremental cost-effectiveness ratio. Bounds are lower and upper 95% confidence bounds
Fig. 3
Fig. 3
Benefit-cost ratio ($ benefits per dollar invested) of introducing the ANC panel Note: Bounds are lower and upper 95% confidence bounds. ANC denotes antenatal care
Fig. 4
Fig. 4
Additional DALYs saved by ANC panel per 1,000 pregnant women by country and infection (with confidence bound) Notes: ANC denotes antenatal care; DALYs denotes disability-adjusted life years. Bars denote lower and upper 95% confidence bound
Fig. 5
Fig. 5
Scatter plots of net costs and net effectiveness by country Note: Each of the 81 points in the scatter plot for each country represents a unique combination of the incidence of the four infections (each with three possibilities) in that country, i.e., 3 × 3 × 3 × 3 = 81. In some cases, the results overlap, so the separate points are not distinguishable. DALYs denotes disability-adjusted life years
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