Understanding micro costing a genomics-based diagnostic in a resource-limited setting: experiences and challenges from a Burkitt lymphoma study in sub-Saharan Africa

Genomic-based diagnostic tests are an important tool that can enable quick and accurate diagnosis. They can also facilitate timely interventions, prevent disease, and potentially improve health outcomes. However, the adoption of these tests has been patchy and most of the use of genomic diagnostics has been in developed countries. This uneven adoption globally is due to many reasons including insufficient evidence on test cost and cost-effectiveness especially in resource constrained settings. One initiative aimed to bring evidence to the decision-makers to expand this technology to developing countries. This initiative is the Aggressive Infection-Related East Africa Lymphoma (AIREAL) study, which is validating a genomic sequencing of circulating tumour deoxyribonucleic acid (DNA) isolated from a simple blood draw called “liquid biopsy” for diagnosis in children with suspected Burkitt lymphoma in Uganda and Tanzania. We undertook a micro costing study of the new sequencing test as an input to a cost-effectiveness analysis and as an input into policy decision on the affordability of new technology but also in the budgeting process. This paper aims to describe the process and potential challenges of applying micro-costing in developing country settings, by reflecting on the experience in practice during data collection. Undertaking micro-costing in East Africa revealed both expected and unexpected challenges. Time constraints was a recurring issue, with clinicians and laboratory staff being too busy to provide data. Weaknesses in local supply chains led to high and variable cost quotes, and philanthropic donations were prevalent which meant that it was difficult to acquire the actual cost of donated equipment and medical supplies. These could be mitigated in future research by early engagement of the health economics team to develop understanding of the costing process among clinical and laboratory colleagues.