OA-272 Health system costs of decentralized TB diagnostic testing with Molbio Truenat MTB/RIF vs. hub-and-spoke GeneXpert MTB/RIF in Mozambique and Tanzania

<h3>Background</h3> Diagnostic testing for TB needs to optimize access, turnaround time and thus time to treatment initiation and cost. Point of care (POC) testing optimizes the former, but additional costs beyond the test cost alone might be drivers of overall cost in a POC testing strategy, especially in low-and-middle-income settings. <h3>Methods</h3> We estimated the health system cost per participant tested for TB on-site via the novel Molbio Truenat MTB/RIF platform (Molbio Diagnostics, Verna, Goa, India) versus the hub-and-spoke standard of care, predominantly off-site testing with Xpert MTB/RIF (Cepheid, Inc., Sunnyvale, CA, USA). We used a health systems perspective, nested in a pragmatic, cluster-randomized trial across 29 clinics (15 intervention, 14 standard of care) among four sites in Mozambique (Sites A and B) and Tanzania (Sites C and D). We estimated ranges for health service delivery costs using trial expense reports, facility assessments, and project staff interviews. <h3>Results</h3> The estimated cost per participant tested using on-site Molbio Truenat was $53 (95% credible interval: $45-$63) in Mozambique [$55 ($47-$64) for Site A and $57 ($50-$64) for Site B], and $42 ($35-$50) in Tanzania [$41 ($36-$47) for Site C and $48 ($39-$57) for Site D]. For the standard-of-care (hub-and-spoke) arm, the cost per participant tested was $40 ($35-$45) in Mozambique [$35 ($33–39) for Site A and $48 ($45-$52) for site B], and $21 ($19-$24) in Tanzania [$23 ($21-$24) for Site C and $20 ($18-$22) for Site D]. Equipment and staffing costs for testing were higher in the decentralized arm, as many of these costs were shared between clinics in the standard-of-care arm. Costs for consumables, training, and communication were comparable across arms. <h3>Conclusion</h3> From a health system perspective, decentralized molecular testing for tuberculosis is more expensive than using a hub-and-spoke approach.