Point of Care Testing Trial Report - Executive Summary
3. Is it the same or more cost-effective to perform PoCT compared with pathology laboratory testing?
- I. Overview
- II. Trial Preparation
III. Key Findings and Conclusions for Key Research Questions- 1. Is it safe to perform PoCT in general pratice?
- 2. Is the effectiveness the same or better than for the same tests using pathology laboratory testing?
- 3. Is it the same or more cost-effective to perform PoCT compared with pathology laboratory testing?
- 4. Are patients and other stakeholders more satisfied with PoCT than with pathology laboratory testing?
- 5. Are there differences between urban, rural and remote geographic regions in any of the parameters measured?
- 6. Would the regulatory environment used for the Trial meet the needs of all the stakeholders if PoCT were to be made more generally available?
- 7. What would be the appropriate Medical Benefits Schedule (MBS) fee for the tests selected in the Trial?
- IV. Evaluation of the POCT Trial Implementation
- V. Overall Conclusions and Summary
A comparative cost analysis and a cost-effectiveness analysis of PoCT in a general practice setting
was undertaken.
A societal perspective was applied to the calculation for comparative costs between PoCT and pathology laboratory testing. An intermediate health outcome indicator, which was the proportion of patients within the therapeutic range for each condition, was used. In order to account for clustering at the patient and practice levels, Generalised Estimating Equations were used to model count and normal data and obtain estimated values for resource use. These values were then used to estimate total and mean costs and group differences. One-way sensitivity analysis was undertaken on all resource items for which the underlying variable had a distribution, using the upper and lower 95% confidence limits as comparative values. Cost-effectiveness was determined using the Incremental Cost Effectiveness Ratio (ICER). Joint probability distributions were also
calculated.
Key Findings
- the INR strategy using PoCT was associated with a small reduction in the indirect costs per patient to the health care sector (95% CI -$16 to -$3)
- the other three PoCT strategies, HbA1c, urine ACR and lipids, did not generate a statistically significant difference in the direct costs per patient to the health care sector over the duration of the Trial
- for INR testing, PoCT was associated with significantly higher costs per patient for GP consultations (95% CI $120 to $367) and pharmaceuticals (95% CI $6 to $30)
- for HbA1c and urine ACR testing, PoCT was not associated with a statistically significant difference in any of the other measured categories of direct costs to the health care sector
- for lipids testing, PoCT was associated with significantly higher costs per patient for pharmaceuticals (95% CI $143 to $296)
- regarding the point estimates of the ICERs:
- INR by PoCT was dominated by its comparator
- for HbA1c, this was $40 per additional patient within the therapeutic range
- for lipids, this was $10,082 per additional patient within the therapeutic range
- for urine ACR, PoCT was dominant
- the one-way sensitivity analysis showed that the costs of all tests were particularly sensitive to hospital admissions
- all PoCT strategies led to a small reduction in patient travel costs and in indirect costs
- because most patients in this Trial were bulk-billed, the overall level of co-payments was low
- the comparative direct costs to the health care sector of the actual tests depend on whether or not the establishment costs, consumables and maintenance costs, and quality assurance and control costs, all of which were provided free during the Trial, should be included.
