背景:非传染性疾病(NCDs)占南非总死亡率的51%,随着高血压(HTN)和糖尿病(DM)负担的上升。将非传染性疾病和COVID-19筛查纳入大规模活动,如COVID-19疫苗接种计划,可以为早期发现干预措施提供显著的长期益处。然而,对相关成本和所需资源的了解有限。我们评估了将NCD筛查和COVID-19抗原快速诊断测试(Ag-RDT)整合到COVID-19疫苗接种计划中的成本。
方法:我们在约翰内斯堡的三家公共部门初级保健诊所和一家学术医院进行了前瞻性成本分析,南非,进行疫苗接种。参与者在2022年5月至12月期间接受资格评估并招募。成本是使用自下而上的微观成本计算方法从提供商的角度估算的,并在2022年报告美元。
结果:在1,376名注册参与者中,240人选择接受COVID-19Ag-RDT,没有人检测出COVID-19阳性。138(10.1%)血压升高,96(70%)没有先前的HTN诊断。22例(1.6%)DM筛查阳性,12(55%)没有事先诊断。非传染性疾病筛查的每人平均费用为1.70美元(IQR:1.38美元-2.49美元),分别。发现血糖水平和血压升高的人均平均提供者费用分别为157.99美元和25.19美元。发现DM和HTN的潜在新病例分别为289.65美元和36.21美元。对于DM和DM+HTN屏幕阳性参与者,诊断测试是主要的成本驱动因素,而员工成本是DM-和HTN屏幕阴性和HTN屏幕阳性参与者的主要成本驱动因素。每个Ag-RDT的成本中位数为$5.95(IQR:$5.55-$6.25),成本主要由测试套件成本驱动。
结论:我们显示了在疫苗队列中发现DM和HTN潜在新病例的成本,这是了解此类举措的可行性和资源需求的重要第一步。然而,有必要进行比较经济分析,包括与护理和保留数据的联系,以充分了解这一成本,并确定是否应将机会性筛查添加到一般的大众卫生活动中.
BACKGROUND: Non-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program.
METHODS: We conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD.
RESULTS: Of the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs.
CONCLUSIONS: We show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities.