Nichols Brooke E, de Nooy Alexandra, Cassim Naseem, Hans Lucia, da Silva Manuel Pedro, Chetty Kamy, Grantz Kyra H, Han Alvin X, Phillips Andrew N, Jamieson Lise, Scott Lesley E, Stevens Wendy S
Impact Department, FIND, Geneva, Switzerland
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
BMJ Glob Health. 2024 Dec 3;9(12):e015830. doi: 10.1136/bmjgh-2024-015830.
To ensure there is adequate investment into diagnostics, an understanding of the magnitude of impact and return on investment is necessary. We, therefore, sought to understand the health and economic impacts of the molecular diagnostic programme in South Africa, to deepen the understanding of the broad value of diagnostics and guide future healthcare investments.
We calculated the 10-year (where data were available) total cost and disability-adjusted life-years (DALYs) averted associated with molecular testing for tuberculosis diagnosis (2013-2022), HIV viral load monitoring (2013-2022), early infant diagnosis of HIV infection (2013-2022) and SARS-CoV-2 testing (2020-2022), based on the actual number of molecular tests conducted in South Africa for the respective time periods. We then calculated the economic value associated with those health gains and subsequent return on investment.
Since the inception of the molecular diagnostics programme in South Africa, approximately 4.3 million DALYs (uncertainty range (UR): 2.8-5.8 million) have been averted as a direct consequence of this programme. This has generated an estimated US$28.3 billion in economic value due to these health gains (UR$18.4-UR$38.7 billion). The return on investment varied by specific diagnostic test (20.3 (UR 15.2-25.4) for tuberculosis, 7.7 (UR 1.6-13.9) for HIV viral load testing, 63.0 (UR 63.0-65.5) for early infant diagnosis of HIV and 2.5 (UR 0.7-4.6) for SARS-CoV-2), for an average of 13.9 (UR 9.0-18.9) for the entire molecular diagnostics programme or US$13.9 of value for each UR$1 invested.
The molecular diagnostics programme in South Africa generated a significant amount of health gains and economic value associated with these health gains. The return on investment rivals other high-impact public health interventions such as childhood vaccination. The molecular diagnostics programme in South Africa is highly impactful and will continue to be an excellent investment in South African public health expenditure.
为确保对诊断领域有足够的投资，有必要了解其影响程度和投资回报率。因此，我们试图了解南非分子诊断项目对健康和经济的影响，以加深对诊断广泛价值的理解，并指导未来的医疗保健投资。
我们根据南非在各个时间段实际进行的分子检测数量，计算了与结核病诊断分子检测（2013 - 2022年）、艾滋病毒载量监测（2013 - 2022年）、婴儿早期艾滋病毒感染诊断（2013 - 2022年）和新冠病毒检测（2020 - 2022年）相关的10年（有数据的情况下）总成本和避免的伤残调整生命年（DALYs）。然后，我们计算了与这些健康收益相关的经济价值以及随后的投资回报率。
自南非分子诊断项目启动以来，该项目直接避免了约430万个伤残调整生命年（不确定性范围（UR）：280万 - 580万）。由于这些健康收益，产生了约283亿美元的经济价值（UR$184亿 - UR$387亿）。不同特定诊断检测的投资回报率有所不同（结核病为20.3（UR 15.2 - 25.4），艾滋病毒载量检测为7.7（UR 1.6 - 13.9），婴儿早期艾滋病毒诊断为63.0（UR 63.0 - 65.5），新冠病毒检测为2.5（UR 0.7 - 4.6）），整个分子诊断项目的平均投资回报率为13.9（UR 9.0 - 18.9），即每投资1个UR$可获得13.9美元的价值。
南非的分子诊断项目带来了大量的健康收益以及与这些健康收益相关的经济价值。其投资回报率可与儿童疫苗接种等其他具有重大影响的公共卫生干预措施相媲美。南非的分子诊断项目具有高度影响力，将继续是南非公共卫生支出的一项出色投资。
