Activity-Based Costing of COVID-19 RT-PCR Testing in Public Laboratories in Indonesia: Evidence for Tariff Setting

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Background: Reverse transcriptase-polymerase chain reaction (RT-PCR) testing has been central to Indonesia's COVID-19 response. However, limited empirical evidence exists on the actual cost of RT-PCR testing in public laboratories, raising concerns that regulated tariffs may not accurately reflect resource use, particularly in low- and middle-income settings. Purpose: This study aimed to estimate the unit cost of COVID-19 RT-PCR testing and identify key cost drivers to inform evidence-based tariff setting and support the financial sustainability of public laboratories in Indonesia. Methods: A micro-costing analysis using an Activity-Based Costing (ABC) approach was conducted across eight government-owned laboratories in Southeast Sulawesi, Indonesia. Costs were categorized into direct and indirect components, and the unit cost was calculated by dividing total operational costs by the average number of tests performed per month. One-way sensitivity analyses were performed to assess the influence of major cost components. Results: The adjusted mean unit cost of RT-PCR testing was USD 21.02, based on an average testing volume of 5409 samples per month and total adjusted monthly operating expenditures of USD 100,973.89. Direct costs accounted for 92.58% of total costs, driven primarily by consumables (75.12%) and human resources (13.32%). Extraction kits and RT-PCR reagents were the most influential cost drivers in sensitivity analyses. The estimated unit cost exceeded the government-mandated RT-PCR tariff outside Java and Bali (approximately USD 17-18.5). Conclusion: This study provides empirical evidence on the actual cost of COVID-19 RT-PCR testing in Indonesian public laboratories. The findings highlight a mismatch between regulated tariffs and real service delivery costs, underscoring the need for tariff adjustments that balance affordability for patients with financial sustainability for laboratories. Transparent cost information is essential to support evidence-based pricing policies and strengthen preparedness for future public health emergencies.

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