- Title
- An assessment of the cost effectiveness and impact of introducing a laboratory electronic gatekeeping system at an academic hospital in Mthatha, Eastern Cape, South Africa
- Creator
- Mayekiso, Zoliswa
- Description
- Monitoring laboratory expenditure is crucial to ensure that laboratory services remain sustainable and affordable. In South Africa, the National Department of Health (NDoH) and its partner, the National Health Laboratory Services (NHLS) collaborated to introduce Electronic Gate Keeping (EGK) systems across the country. Countries across the globe report an increase in expenditure associated with medical laboratory testing. In 2020, the United States Department of Health and Human Services reported that laboratory test expenditures increased by $459 million from $7.1 billion in 2018. In South Africa, laboratory testing expenditure in the public sector increased from $415 million (R4.5 billion) in 2014 to $723 million (R10.7 billion) in 2021. Many countries, including South Africa, are developing, and testing new methods to reduce the excessive demand for medical laboratory tests for patient investigations to reduce the burden of rising laboratory costs on national budgets. The aim of the study is to assess the cost-effectiveness and impact of introducing a laboratory electronic gate keeping system at an academic hospital in Mthatha, Eastern Cape, South Africa. Objectives: This study addressed four goals which are: (i) Evaluated the impact of the EGK intervention by obtaining the number of inappropriately requested test investigations averted and cost associated (cost savings) at Nelson Mandela Academic Hospital (NMAH), Eastern Cape, between 1st June 2015 to 31st May 2017. (ii) Determined the costs associated with inappropriately requested test investigations analysed prior to the implementation of EGK at NMAH, Eastern Cape, from 1st June 2013 to 31st May 2015. (iii) Determined the costs associated with inappropriately xxxiii requested test investigations analysed during the implementation of EGK at NMAH, Eastern Cape, from 1st June 2015 to 31st May 2017. (iv) Evaluated the costs and cost effectiveness analysis of introducing and implementing EGK at NMAH, Eastern Cape, between 1st June 2015 to 31st May 2017. Methods: In addressing the four objectives, this study was undergone in four phases, making use of secondary data on laboratory expenditure, primarily collected electronically by the NHLS and supplied to NMAH on monthly basis. In objective 1 and phase 1 of the study, a cross sectional study design to retrospectively audit EGK subjected tests at the NHLS in Mthatha by Nelson Mandela Academic Hospital over 24 months was employed. In objective 2 and 3 and phase 2 of the study, a cross-sectional study using an interrupted time series analysis (ITSA) to determine the impact of the EGK intervention was employed. In this phase, two periods comparing laboratory expenditure before and during the EGK intervention were analysed over a period of 24 months. In objective 4 and phase 3 of the study, a cross-sectional study that used cost effectiveness analysis (CEA) to evaluate a cost effectiveness of EGK intervention over 24 months was done. Results: In the first phase, we found that out of 448 028 tests requested, 17,480 (3.9%) were rejected after being identified as unnecessary through the EGK system. This rejection rate of 3.9% generated cost savings of $51,967.07 (R807,110.95). The top three tests that generated the most savings were the c-reactive protein with $6,077.68 (R94,393.59), free thyroxine with $5,199.92 (R80,760.94) and hepatitis A IgM with $3,813.61 (R59,229.98). In the second phase, our results demonstrated that xxxiv there was a significant reduction (211,928 fewer tests) in the number of tests performed during the intervention (434,790) compared to before the intervention (646,718). Laboratory test expenditure was $1,663,756.72 (R24,823,250.26) before the intervention period and $1,105,036.88 (R1,567,150.25) during the intervention period, demonstrating a cost savings of $558,719.84 (R8,336,100.01). In the last phase 3, results showed that implementing EGK resulted in lower costs - $515,114.96 (R7,685,515.20) and 212 fewer tests, resulting in an Incremental Cost Effectiveness Ratio (ICER) of USD 2,430.00 (R36,255.60) which is evidence is needed to evaluate the cost effectiveness of EGK in South Africa from a societal perspective.
- Description
- Thesis Phd -- Faculty of Medicine and Health Sciences, 2024
- Date
- 2024-00
- Subject
- Medicine and Health Scienes
- Type
- Doctoral theses, text
- Identifier
- http://hdl.handle.net/11260/13042
- Identifier
- vital:76864
- Format
- computer, online resource, application/pdf, 1 online resource (179 leaves), pdf
- Publisher
- Walter Sisulu University, Faculty of Medicine and Health Sciences
- Language
- English
- Rights
- Faculty of Education Sciences, All Rights Reserved, Open Access
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- Visitors: 8
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details | SOURCE1 | Zoliswa Mayekiso Thesis - 26.07.2024.pdf | 8 MB | Adobe Acrobat PDF | View Details |