PMID- 34746931
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240214
IS  - 2767-3375 (Electronic)
IS  - 2767-3375 (Linking)
VI  - 1
IP  - 10
DP  - 2021
TI  - Antimicrobial resistance detection in Southeast Asian hospitals is critically 
      important from both patient and societal perspectives, but what is its cost?
PG  - e0000018
LID - 10.1371/journal.pgph.0000018 [doi]
LID - e0000018
AB  - Antimicrobial resistance (AMR) is a major threat to global health. Improving 
      laboratory capacity for AMR detection is critically important for patient health 
      outcomes and population level surveillance. We aimed to estimate the financial 
      cost of setting up and running a microbiology laboratory for organism 
      identification and antimicrobial susceptibility testing as part of an AMR 
      surveillance programme. Financial costs for setting up and running a microbiology 
      laboratory were estimated using a top-down approach based on resource and cost 
      data obtained from three clinical laboratories in the Mahidol Oxford Tropical 
      Medicine Research Unit network. Costs were calculated for twelve scenarios, 
      considering three levels of automation, with equipment sourced from either of the 
      two leading manufacturers, and at low and high specimen throughput. To inform the 
      costs of detection of AMR in existing labs, the unit cost per specimen and per 
      isolate were also calculated using a micro-costing approach. Establishing a 
      laboratory with the capacity to process 10,000 specimens per year ranged from 
      $254,000 to $660,000 while the cost for a laboratory processing 100,000 specimens 
      ranged from $394,000 to $887,000. Excluding capital costs to set up the 
      laboratory, the cost per specimen ranged from $22-31 (10,000 specimens) and 
      $11-12 (100,000 specimens). The cost per isolate ranged from $215-304 (10,000 
      specimens) and $105-122 (100,000 specimens). This study provides a conservative 
      estimate of the costs for setting up and running a microbiology laboratory for 
      AMR surveillance from a healthcare provider perspective. In the absence of donor 
      support, these costs may be prohibitive in many low- and middle- income country 
      (LMIC) settings. With the increased focus on AMR detection and surveillance, the 
      high laboratory costs highlight the need for more focus on developing cheaper and 
      cost-effective equipment and reagents so that laboratories in LMICs have the 
      potential to improve laboratory capacity and participate in AMR surveillance.
FAU - Roberts, Tamalee
AU  - Roberts T
AD  - Lao-Oxford-Mahosot Hospital- Wellcome Trust Research Unit, Mahosot Hospital, 
      Vientiane, Lao People's Democratic Republic.
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
FAU - Luangasanatip, Nantasit
AU  - Luangasanatip N
AD  - Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, 
      Mahidol University, Bangkok, Thailand.
FAU - Ling, Clare L
AU  - Ling CL
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
AD  - Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae 
      Sot, Thailand.
FAU - Hopkins, Jill
AU  - Hopkins J
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
AD  - Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 
      Cambodia.
FAU - Jaksuwan, Risara
AU  - Jaksuwan R
AD  - Lao-Oxford-Mahosot Hospital- Wellcome Trust Research Unit, Mahosot Hospital, 
      Vientiane, Lao People's Democratic Republic.
FAU - Lubell, Yoel
AU  - Lubell Y
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
AD  - Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, 
      Mahidol University, Bangkok, Thailand.
FAU - Vongsouvath, Manivanh
AU  - Vongsouvath M
AD  - Lao-Oxford-Mahosot Hospital- Wellcome Trust Research Unit, Mahosot Hospital, 
      Vientiane, Lao People's Democratic Republic.
FAU - van Doorn, H Rogier
AU  - van Doorn HR
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
AD  - Oxford University Clinical Research Unit, National Hospital for Tropical 
      Diseases, Hanoi, Vietnam.
FAU - Ashley, Elizabeth A
AU  - Ashley EA
AD  - Lao-Oxford-Mahosot Hospital- Wellcome Trust Research Unit, Mahosot Hospital, 
      Vientiane, Lao People's Democratic Republic.
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
FAU - Turner, Paul
AU  - Turner P
AD  - Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, 
      University of Oxford, Oxford, United Kingdom.
AD  - Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 
      Cambodia.
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
GR  - 215867/WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
DEP - 20211013
PL  - United States
TA  - PLOS Glob Public Health
JT  - PLOS global public health
JID - 9918283779606676
PMC - PMC7611947
MID - EMS137076
COIS- Competing interests We declare that we have no conflicts of interest.
EDAT- 2021/11/09 06:00
MHDA- 2021/11/09 06:01
PMCR- 2021/10/13
CRDT- 2021/11/08 07:00
PHST- 2021/11/08 07:00 [entrez]
PHST- 2021/11/09 06:00 [pubmed]
PHST- 2021/11/09 06:01 [medline]
PHST- 2021/10/13 00:00 [pmc-release]
AID - PGPH-D-21-00306 [pii]
AID - 10.1371/journal.pgph.0000018 [doi]
PST - epublish
SO  - PLOS Glob Public Health. 2021 Oct 13;1(10):e0000018. doi: 
      10.1371/journal.pgph.0000018. eCollection 2021.