Economic evaluation of quantitative point-of-care testing versus spectrophotometric assay for population screening of glucose-6-phosphate dehydrogenase deficiency in Malaysia: A time-driven activity-based cost analysis.

Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is a common genetic disorder that can lead to life-threatening complications, including acute hemolytic anemia. Effective screening using advanced technology, such as point-of-care test (POCT), is critical to ensure proper clinical management, particularly in malaria-endemic areas. However, economic evidence of the quantitative POCT, such as cost structure, cost-effectiveness, and potential areas for cost savings, particularly in developing countries, including Malaysia, is scarce. A top-down and time-driven activity-based costing was conducted at the Canselor Tuanku Muhriz Hospital, Malaysia, between February 1 and 28, 2023, for the CareStart™ Biosensor S1 (CBS1) and compared with the OSMMR-2000D test, focusing on the duration to perform the screening test for G6PDd (i.e. cost per minute of turnaround time). The activities, items, and individuals involved were identified using the activity-based costing form, which includes a workflow and detailed breakdown tables. The capital cost, recurrent cost, and total expenditure for both methods were determined. Univariate sensitivity analysis was conducted by adjusting several key variables, such as human resources, disposable items, and equipment costs, by a 20% increase or decrease, and analyzing their effect on the overall cost structure. In 2023, the cost of G6PDd screening using the CBS1 in Malaysia was RM47.54 (USD11.15) per test, compared with a higher cost of RM246.27 (USD54.18) per test with the OSMMR-2000D. It has been demonstrated that the major cost division for CBS1 was in the disposable item cost (58.18%), which includes the device's strips and reagents, whereas the major cost division for OSMMR-2000D was in the transportation (59.72%). The univariate sensitivity analysis revealed that the disposable item cost for CBS1 was the most sensitive parameter, which affected the total expenditure the most. This study provides valuable economic evidence on the efficiency of quantitative POCT for G6PDd. In countries with high G6PD prevalence as in Malaysia, such screening efficiency is crucial, as it would not only improve patient outcomes but also significantly reduce overall healthcare expenditures. This analysis proved that G6PDd screening using POCT is more cost-effective and time-efficient, and the method should be a policy priority for rapid, mobile, and remote screening of targeted populations.