Cost effectiveness of Electronic Gate Keeping (EGK) system on laboratory tests demand at a rural academic hospital in Eastern Cape, South Africa: a cross sectional study

Background: Monitoring laboratory expenditure is crucial to ensure that laboratory services remain sustainable and affordable. In South Africa, the National Department of Health (NDoH) and its partner, the National Health Laboratory Services (NHLS) collaborated to introduce Electronic Gate Keeping (EGK) systems across the country. This study estimated the cost-effectiveness of EGK on laboratory tests requested at a rural academic hospital in the Eastern Cape province of South Africa. Methods: The methodological approach involved the use of a crosssectional study design. For 24 months (June 2015 to May 2017), data on the number and types of laboratory tests initially requested along with those rejected because there were unnecessary was obtained. Data management and cost effectiveness analysis to estimate cost savings due to EGK on laboratory test demands were carried out using MS Excel and Stata software. There were 28 types of tests requested, of which 22 were chemical tests, two were haematological tests, and four were serological tests. Results: Out of 448 028 tests requested, 17,480 (3.9%) were rejected after being identified as unnecessary through the EGK system. This rejection rate of 3.9% generated cost savings of USD 51,967.07. The top three tests that generated the most savings were the c-reactive protein (USD 6,077.68), free thyroxine (USD 5,199.92) and hepatitis A IgM (USD 3,813.61). The study demonstrates that the introduction of EGK has positive spinoffs; it reduced costs, strengthened the dialogue between clinicians and pathologists allowing a platform for continuous education, teaching and learning.