In yet another bungle in its efforts to contain the spread of Covid-19, the government has decided to reduce the cost of real-time polymerase chain reaction (PCR) tests by half and this, private laboratories say, is only possible using low-quality testing kits and antigen, thereby raising questions over the reliability of their reports.

The Ministry of Health and Population on Sunday brought down the cost of one PCR test from Rs4,400 to Rs2,000 arguing that the cost of the extraction kits and antigen had come down significantly in recent times.

“Private laboratories can easily carry out the tests at the given price using testing material as prescribed by the government,” Dr Jageshwor Gautam, spokesperson for the ministry, told the Post. “The decision on price reduction was taken after calculating the market price which has come down significantly in recent times and other related costs.”

But private laboratories that conduct PCR tests are unhappy with the decision saying that the government didn’t consult with them beforehand.

“It is impossible for us to conduct the test at this price,” said Dr Jyotindra Sharma, executive director at Hospital for Advanced Medicine and Surgery, which has been permitted to conduct PCR tests. “The decision is based on the price the government pays for extraction kits and reagents. Private laboratories cannot purchase in bulk as the government does. Therefore, their cost is higher.”

Private laboratories are only allowed to use the kits and antigen that are either approved by the United States Food and Drug Administration or recommended by the World Health Organisation.

“Carrying out the test for the government’s price is only possible if substandard materials are used,” said Sameer Mani Dixit, director of research at Center for Molecular Dynamics Nepal, another private laboratory that conducts PCR tests. “Such tests are completely unreliable. There are extraction kits and antigen available in the market that cost less than Rs 1,000 but their results are not going to be better than a coin toss.”

The new price set by the government comes at a time when there have been questions about the reliability of tests.

The Health Ministry has already received a complaint about the variability of reports from different laboratories.

Gautam, the ministry spokesman, said they are investigating a case where four laboratories gave different reports on throat swabs collected from the same person. While two laboratories showed him to be positive, the other two gave negative reports.

“We are trying to find out whether it is due to a compromise in quality or it is a technical issue,” he said.

The monitoring division of the ministry has been monitoring the different laboratories recently.

Dr Bikash Devkota, head of the division, said they, together with the World Health Organisation’s Nepal office, have carried out a study whose report is expected within a few days.

“The report will show the status of different laboratories that are conducting tests for Covid-19,” he told the Post.

Runa Jha, director at the National Public Health Laboratory, said there are monitoring mechanisms in place to control if some try to compromise in the quality.

“There are malpractices in every sector but that can be controlled if we conduct strong monitoring,” she told the Post. The government has prepared guidelines for the operationalisation of Covid-19 testing, which needs to be followed by every laboratory. It talks about the equipment and human resource to the arrangement of other necessities to conduct real-time PCR.

Of the 47 laboratories that are carrying out Covid-19 tests in the country, 13 are private.

Operators of the private laboratories said they are helpless as their running cost is higher than the price determined by the government. The representatives of the private sectors met the officials at the ministry to express their displeasure and asked them to roll back its decision. Ministry officials, according to the private lab operators, said they were positive but no decision to return to the previous pricing was taken on Monday.

The private laboratory operators have also issued a statement saying they will not be able to provide the service for Rs 2,000.

According to Dixit, each PCR test costs at least Rs 3,500 when it is carried out by qualified human resource using high-quality testing materials.

The government had fixed Rs 5,500 per PCR test when it was opened for the private sector in June. The price was reduced to Rs 4,400 on August 30.

Dr Chakra Raj Pandey, medical director at Grande International Hospital, said the government reduced the price by half just in 15 days without any consultations. “Such abrupt decisions are demotivating,” he told the Post. “Such decisions should be made after proper evaluation of their consequences.”

“We would rather stop our services if the government didn’t revisit its decision,” said Sharma of the Hospital for Advanced Medicine and Surgery.