Point of Care Patient Testing (POCT)
ONPS 2425 / 2426
Assignment 2
Title: The Economics of POCT
(Glucose and cholesterol)
Naif Alhawiti
S3211070
Course Coordinator: Dr. Ronda Greaves
Due Date: 15th October 2010
The cost of POCT to measure Glucose and Cholesterol levels in patients
POCT, a new concept in modern medical care provision, stands for Point of Care Testing of patients1-2 and it is done at the exact location of the patient3. This is executed even by those that can be considered not qualified in medical terms since the tools of trade for the successful execution of this mode of health care provision do not need a lot of training and virtually any literate individual is capable of carrying them out4,5.This is a salient characteristic of POCT. More often than not, the chemicals whose presence is tested are cholesterol, glucose, creatine, and such other analytes that usually lead to development of many lifestyle diseases such as hypoglycemia 6. It is already indicated that POCT is carried out at the area of the subject and this actually brings this vital medical service to the door step of the patient. The overall costs of POCT administration for Glucose or Cholesterol level testing are elaborately given below3, 5, and 6.
Total and cost per item (higher estimates) 5, 4.
Table 1: The fixed cost of using POCT ( per day).
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Table 2: The variable cost of using POCT ( per day).
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The sources from which the above figures were obtained; what the authors regarded as very general and it is therefore proposed here that individuals should arm themselves with at least the indicated amounts so as to be sure of acquiring the gadgets since the figures given are upwardly adjusted. This paper tries to unify the figures to give a presentation of the real picture as it occurs in the field. Therefore the prices are appropriate in several parts of the republic5, 4, and7.
The cost justification for POCT
As can be seen from this study, the cost is obvious justified. By following this survey most important aspects of cost of POCT are presented as well.
As it can be evidently seen from the table above, infrastructural costs for both glucose and cholesterol testing apparatus were $ 30 and $ 40 respectively. These alone are seen to be more than double the costs of doing the same tests within a centralized setting like a laboratory which in most cases stands at an average cost that is between $17 and $ 20. The reagent cost for each case was found to be $ 25. Maintenance costs, capital and amortization schedule, calibration QC and Quality analysis costs for both procedures were the same and were estimated to be $ 30, $ 50, and $ 10 respectively.
As far as record keeping and patient information costs are concerned, the values were at $ 35 and $ 30 respectively. Training of handlers and accreditation and compliance costs stood at estimates of $ 60 and $ 25 for glucose testing, and $ 70 and $ 30 for cholesterol checks. Labor costs, costs of initial implementation, documentation and ongoing document review were similar at $ 60 and $ 70 each. It was also envisaged that there could be miscellaneous expenses which were then factored in the estimates and were indicated as $ 20 for each case. Generally, it was seen that the overall cost for cholesterol testing was $ 20 more than that for glucose testing. This is clearly seen to be several times higher than the cost of performing similar teats in a centralized laboratory.
The relevance of “fixed costs” and “variable costs”
In any economic investigation requiring valuation and costing, both fixed and varying costs are critically looked at. Fixed values don’t change, for example, the cost of the gadgets and the required chemicals are fixed. However, variable costs may change with circumstances for e.g. records, labor costs and that for documentation change depending on the individuals who perform them8. For analysis of blood glucose level one gadget can be used by a number of people6. This however depends on the implement used since other glucose analyzers are meant for just one user. Where a single machine is used to test a number of patients, the number of tests here will obviously reduce the first cost of the test by a very large value. The other costs such as labor charges, record taking, keeping of the records and such other costs are directly dependent on the number of people being tested. However, cholesterol levels determinations, whether partial or total cholesterol measurements all costs are directly dependent on the number of patients. This is because each patient needs his or her own testing kit5, 4 and7. Other costs in the vote heads such cost of chemicals reagents, recordings and the reporting of data are clearly seen to be directly hinged on to the number of subjects in question.
The influence which testing volume may have on the overall costing
From this survey, the testing quantity does not have any influence on the fixed costs. However, the variable costs have been influenced. The reason is that the variation costs are changed, while the fixed costs are still stabilized on the processing of POCT. Eventually, the testing volume will be influenced as well as the overall cost has might be moved up.
A comparative estimate of central laboratory costs for the same tests
In a nutshell the figures shown above clearly indicate that testing a number of people will directly increase the overall cost on average. If these tests were to be carried out in centralized places such as public or private laboratories, as suggested in many quarters, it will be bring about the economic significance of economies of large scale. This is brought about by the fact that laboratory technologists are already well trained on the testing procedures, and that the equipments and chemicals to be used already exist in the laboratory, obviously bringing down the overall costs. The only other requirement for the patient is that he or she must bring him or herself to the testing centre. Otherwise, they cannot be tested because the services are done from a centralized point2, 9, and 10. Having looked at these dynamics, POCT may be a little more expensive approach than if the tests were done centrally as done in laboratories2. However, there remains to be other benefits for example testing people right where they are whether in houses or offices bringing an exclusive convenience to the whole affair, something seen to encourage the general population to get tested, hence reaping the long term benefits of reducing the effects of lifestyle diseases like heart conditions and sugar diabetes11.
The cost efficiency with regard to patient treatment and on-going management
Patient treatment and continuous management of POCT as a testing system, is clearly seen to be effective in terms of costs12, 13. Since it centralizes in an individualized system of preventing and controlling these diseases, it is seen to hugely reduce both the socioeconomic implications and the adverse effects of several lifestyle conditions to a large extent. Many more people will find it possible of taking the tests to determine whether or not they are in a dangerous predisposition as far as these diseases are concerned2, 14.
Suggestions for cost recovery cross subsidization, patient or Medicare billing
Having had a critical investigation of POCT verses centralized testing as done in most laboratories; it is evident that the former method is relatively more expensive than the latter. But the examination in this paper also reveals that even though POCT is expensive, its benefits cannot be underrated since it is the most convenient method of running these life saving tests in some very special cases where mobility is a challenge to the patient, it is with regard to this that this method is strongly advocated for an the government is strongly advice to consider giving subsidies as far as the equipment and reagents involved in POCT are concerned11, 14 and 15. This will reduce the cost and encourage more people to get tested, further bringing down the risks associated with lifestyle diseases.
References
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Kost, G. J. Principal practices of point-of-care testing and Evaluation in Thailand. London: Hagerstown. 2006.
Schimke I. Quality and Timeliness in Medical Laboratory Testing. Annal Bioanal Chem. 2009; 393: 1499-1504.
Kost, G.J. (2006). Point-of-care testing in hospitals clinics and primary units (PCUs).
