Cost Analysis of Conventional Antimicrobial Resistance Diagnostics in Zambia: Evidence for Sustainable Laboratory Investment in Resource-Limited Settings
Abstract:
Antimicrobial resistance
(AMR) is a growing global health threat, particularly in low- and middle-income
countries (LMICs) like Zambia, where diagnostic capacity is limited, and
funding constraints hinder effective response. This study aimed to assess the
per-test cost of conventional AMR diagnostic methods, Gram stain, culture, and
antimicrobial susceptibility testing (AST), to support sustainable investments
and policy decisions. Between December 2024 and March 2025, data were collected
from 13 laboratories across nine provinces in Zambia using structured
questionnaires. Inputs related to labour, reagents, and equipment were analysed
using the WHO Laboratory Testing Costing Tool (LTCT) and Julius AI. Pricing
adhered to Zambia’s Public Procurement Act, and ethical approvals were obtained
from UNZABREC and NHRA. Results showed that test costs varied widely by input
type. Gram stains were the least expensive at $3.15 per test, while enriched
media like Blood/Chocolate agar reached $4.92 due to high labour and reagent
requirements. Biochemical test costs ranged from $4.25 to $7.99, with Coagulase
being the most expensive due to reagent costs. Testing for WHO-priority
pathogens, such as E. coli and K. pneumoniae, costs approximately $37–38 per
test, while testing for Neisseria gonorrhoeae costs $42. Sensitivity analysis
identified reagents as the primary cost driver across all test types. Batch
testing was cost-effective only for tests with high fixed costs, such as Blood
Culture. This study underscores the importance of standardized costing,
context-specific planning, and bulk procurement in sustaining affordable
diagnostics in resource-limited settings. Future research should incorporate
indirect costs to provide a comprehensive understanding of laboratory financial
needs.
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