Implementing an electronic gate keeping (EGK) intervention at a rural academic tertiary hospital in South Africa over a two-year period: A cost effectiveness analysis

Abstract Background Many countries, including South Africa, are developing, and testing new methods to reduce the excessive demand for medical laboratory tests for patient investigations to reduce the burden of rising laboratory costs on national budgets. The objective of this study was to compare the cost effectiveness of an electronic gate keeping intervention implemented at a rural academic tertiary hospital in the Eastern Cape province, South Africa. Methods A cost effectiveness analysis (CEA) was performed in this cross-sectional study, taking only direct costs associated with implementing EGK into account. The incremental cost effectiveness ratio (ICER) was calculated over a 48-months period using the World Health Organization (WHO) threshold recommendation. According to the WHO-CHOICE threshold recommendation, for a cost to be considered ‘very cost effective,' it must be one time the Gross Domestic Product Per Capita (GDPPC) of the country in question. South Africa's GDPPC in 2021 was USD 7,055. A t-test was also used to investigate statistical differences in costs and number of tests performed 24 months prior to the intervention and during the intervention period of 24 months. The statistical level of significance was set at 0.05. Results The results showed that implementing EGK resulted in lower costs - $515,114.96 - and 212 fewer tests, resulting in an ICER of USD 2,430.00 which is < 1 times GDPPC of South Africa in 2021. Also, the pre-intervention period had significantly higher mean costs than the EGK intervention period (M = 69,831.14, SD = 11,059.39 vs. M = 48,368.01, SD = 4,505.96; t 30.43 = 8.81, p < 0.01). Similarly, the number of laboratory tests showed a statistically significant difference in the mean number of tests performed pre the intervention and during the intervention (M = 26,946.58 SD = 4,330.76 vs. M = 18,116.25 SD = 1,695.71; t 29.890 = 9.30, p  < 0.01). Conclusions EGK implementation at the rural academic tertiary hospital was very cost effective, based on (WHO)-CHOICE criteria. However, the results are grounded in conditions at the selected hospital; more evidence is needed to evaluate the cost effectiveness of EGK in South Africa from a societal perspective.