Focus/Spotlight

PCR testing : A costly affair for many

By Maheesha Mudugamuwa 

With the increasing number of Covid-19-positive cases reported within the country, concerns have now risen over the varying prices of PCR tests offered by private hospitals accredited by the Ministry of Health. 

 

In parallel to the increasing number of positive cases, the demand for tests has also increased. Some factories approved by the Board of Investments (BOI) were already instructed by the authorities to conduct PCR tests for their employees from private hospitals. 

Colombo Municipal Council continues to collect random samples for PCR testing. Photo Pradeep Dambarage

Since testing is vital to eradicate the spread of the virus in society, and with the limited facilities and resources available with the Government, questions are also raised over the affordability of a PCR test from a government-accredited private laboratory. 

In May, the Ministry of Health permitted five private hospitals to conduct PCR tests under strict guidelines. In addition, strict guidelines were also issued by the Ministry to inform them about the patient prior to the test as well as the results of each test. 

Accordingly, private hospitals are to follow all Covid-19-related guidelines and are not allowed to give publicity to any Covid-19-related activities at hospitals. Moreover, the hospitals are also to follow a mechanism to trace the history of all patients. 

However, the Ministry also issued guidelines that capped the cost of sample testing by private labs at Rs. 6,000, which is yet to be gazetted. Although the price was decided after discussing with private hospitals, it had been a mere verbal agreement. 

Govt. can request pvt. hospitals 

As learnt by The Sunday Morning, the price of a PCR test in different private hospitals approximately varies between Rs. 6,500 and Rs. 8,800. 

The main reason for these varying prices was due to adding the cost for other services (i.e. transport, etc.) in addition to the test they provide for the patient, it is learnt. 

When contacted by The Sunday Morning, Association of Private Hospitals and Nursing Homes (APHNH) President Dr. Lakith Peiris said the reason for the cost variation was mainly due to the variations in the operational costs in each private hospital. 

The operating costs of different machines vary; the operating cost is dependent on the type, size, and various other conditions of the machine, he stressed. 

“If you have a large-capacity machine and you want to generate reports quickly but you don’t feed the machine with its full capacity, then the operating cost naturally goes up. For example, if the machine can do 300 in one go and there are only 50 samples, the operating cost will be more. That can be one reason,” Dr. Peiris noted. 

When asked whether the prices can be reduced, he noted that the Government could request from private hospitals and see the possibility of reducing the price. 

“The Government is conducting PCR tests at a cost, but the private sector cannot do so. It has to pay the price of the human resources as human resources do not come freely to the private hospitals,” he said. 

He said that everybody knows the country should conduct more tests but the Government did not have the capacity. 

“That is one reason why the Government has recommended some private sector companies to get the tests done from private hospitals,” he stressed. 

Explaining further, Dr. Pieris said that imposing a cap of Rs. 6,000 per test was not a scientifically decided price but a request made by the Government. He however stressed that the cost per test is high when considering all the factors taken into account, including the payments for the consultants and human resources. 

Initially, testing was intended to be diagnostic and confirm infections in people with symptoms such as cough, fever, shortness of breath, and fatigue. At that time, there was no understanding of the risk of silent transmission within the community via infected people who had not yet developed symptoms or who never developed them, it is learnt. 

According to Stat, a US-based media organisation, given that diagnostic focus, the coronavirus testing capacity emphasised the use of highly sensitive PCR tests that rely on amplifying DNA copies of the RNA in SARS-CoV-2, the virus that causes Covid-19. 

As per international media reports, in the US, while the antibodies test cost about $ 50, the PCR swab test typically costs between $ 100 and $ 200, which adds up when scaling to hundreds of millions of tests. 

When contacted by The Sunday Morning, Ministry of Health Spokesman Dr. Jayaruwan Bandara said the reason for the varying prices was due to the services provided by the respective hospital to their patients, which includes providing personal protection equipment (PPEs). However, he said that generally, as per government regulations, the price per PCR test was Rs. 6,000. 

Commenting on the various tests that can be applied, Dr. Banadara said that discussions are ongoing, seeking the possibilities of using antibody tests for Covid-19. 

P’ment takes up matter 

Meanwhile, more concerns have been raised last week in Parliament over the request made by the BOI, urging factory owners to direct their employees to get the PCR test done from private hospitals. 

These concerns were raised by Samagi Jana Balawegaya (SJB) MP S.M. Marikkar over the inability of government hospitals to conduct PCR tests, stressing that the factory owners would have to bear the PCR test cost that would amount to millions of rupees. 

Marikkar further noted that taking into consideration the situation already faced by factory owners due to the Covid-19 pandemic-related financial slumps, factory owners would be further hampered by the decision taken by the BOI. 

In its response to the increasing demand for PCR tests in private hospitals, Sri Lanka Association of Government Medical Laboratory Technologists (SLGMLT) President Ravi Kumudesh stressed that the Ministry of Health had not discussed with the MLTs who conducted the tests whether there was a possibility of conducting such a large number of tests. 

“We can conduct more than 4,000 tests per day, and conducting tests for factory employees will not be a problem for government laboratories,” he said, adding that there were issues regarding the tests conducted by the private hospitals, as there was nobody to take responsibility. 

“In the recent incident, government laboratories had not conducted tests on Brandix employees who are now said to have arrived from India. So, there is an issue. Who will take the responsibility?” Kumudesh questioned. 

He also noted that the PCR test is not the only testing method that can be applied to confirm the Covid-19 virus, but that there are several testing methods which are easy to conduct. The Ministry of Health had made the PCR test compulsory prior to even looking at other options, he added. 

Tests according to WHO 

In April, the World Health Organisation (WHO) listed the first two diagnostic tests for emergency use during the Covid-19 pandemic. The move should help increase access to quality-assured, accurate tests for the disease. It also means the tests can now be supplied by the United Nations (UN) and other procurement agencies supporting the Covid-19 response. 

In vitro diagnostics, the tests carried out are genesig® Real-Time PCR COVID-19 and cobas® SARS-CoV-2 Test for use on the cobas® 6800/8800 Systems. 

The emergency use listing procedure (EUL) was established to expedite the availability of diagnostics needed in public health emergency situations. It is intended to help procurement agencies and countries navigate the large presence of different devices on the market and, by assessing them, provide assurance of the products’ quality and performance. 

Genesig® Real-Time PCR COVID-19 is an open system more suitable for laboratories with moderate sample testing capacity, while the cobas® SARS-CoV-2 Test for use on the cobas® 6800/8800 systems is a closed system assay for larger laboratories.