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Opuni M, Sanchez-Morales JE, Figueroa JL, Salas-Ortiz A, Banda LM, Olawo A, Munthali S, Korir J, DiCarlo M, Bautista-Arredondo S. Estimating the cost of HIV services for key populations provided by the LINKAGES program in Kenya and Malawi. BMC Health Serv Res 2023; 23:337. [PMID: 37016402 PMCID: PMC10071702 DOI: 10.1186/s12913-023-09279-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/13/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Data remain scarce on the costs of HIV services for key populations (KPs). The objective of this study was to bridge this gap in the literature by estimating the unit costs of HIV services delivered to KPs in the LINKAGES program in Kenya and Malawi. We estimated the mean total unit costs of seven clinical services: post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), HIV testing services (HTS), antiretroviral therapy (ART), sexually transmitted infection (STI) services, sexual and reproductive health (SRH) services, and management of sexual violence (MSV). These costs take into account the costs of non-clinical services delivered alongside clinical services and the pre-service and above-service program management integral to the LINKAGES program. METHODS Data were collected at all implementation levels of the LINKAGES program including 30 drop-in-centers (DICs) in Kenya and 15 in Malawi. This study was conducted from the provider's perspective. We estimated economic costs for FY 2019 and cost estimates include start-up costs. Start-up and capital costs were annualized using a discount rate of 3%. We used a combination of top-down and bottom-up costing approaches. Top-down methods were used to estimate the costs of headquarters, country offices, and implementing partners. Bottom-up micro-costing methods were used to measure the quantities and prices of inputs used to produce services in DICs. Volume-weighted mean unit costs were calculated for each clinical service. Costs are presented in 2019 United States dollars (US$). RESULTS The mean total unit costs per service ranged from US$18 (95% CI: 16, 21) for STI services to US$635 (95% CI: 484, 785) for PrEP in Kenya and from US$41 (95% CI: 37, 44) for STI services to US$1,240 (95% CI 1156, 1324) for MSV in Malawi. Clinical costs accounted for between 21 and 59% of total mean unit costs in Kenya, and between 25 and 38% in Malawi. Indirect costs-including start-up activities, the costs of KP interventions implemented alongside clinical services, and program management and data monitoring-made up the remaining costs incurred. CONCLUSIONS A better understanding of the cost of HIV services is highly relevant for budgeting and planning purposes and for optimizing HIV services. When considering all service delivery costs of a comprehensive HIV service package for KPs, costs of services can be significantly higher than when considering direct clinical service costs alone. These estimates can inform investment cases, strategic plans and other budgeting exercises.
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Affiliation(s)
| | - Jorge Eduardo Sanchez-Morales
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Jose Luis Figueroa
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Andrea Salas-Ortiz
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | | | | | | | | | | | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico.
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2
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Goswami M, Daultani Y, Paul SK, Pratap S. A framework for the estimation of treatment costs of cardiovascular conditions in the presence of disease transition. ANNALS OF OPERATIONS RESEARCH 2022; 328:1-40. [PMID: 36035451 PMCID: PMC9396609 DOI: 10.1007/s10479-022-04914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
The current research aims to aid policymakers and healthcare service providers in estimating expected long-term costs of medical treatment, particularly for chronic conditions characterized by disease transition. The study comprised two phases (qualitative and quantitative), in which we developed linear optimization-based mathematical frameworks to ascertain the expected long-term treatment cost per patient considering the integration of various related dimensions such as the progression of the medical condition, the accuracy of medical treatment, treatment decisions at respective severity levels of the medical condition, and randomized/deterministic policies. At the qualitative research stage, we conducted the data collection and validation of various cogent hypotheses acting as inputs to the prescriptive modeling stage. We relied on data collected from 115 different cardio-vascular clinicians to understand the nuances of disease transition and related medical dimensions. The framework developed was implemented in the context of a multi-specialty hospital chain headquartered in the capital city of a state in Eastern India, the results of which have led to some interesting insights. For instance, at the prescriptive modeling stage, though one of our contributions related to the development of a novel medical decision-making framework, we illustrated that the randomized versus deterministic policy seemed more cost-competitive. We also identified that the expected treatment cost was most sensitive to variations in steady-state probability at the "major" as opposed to the "severe" stage of a medical condition, even though the steady-state probability of the "severe" state was less than that of the "major" state.
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Affiliation(s)
- Mohit Goswami
- Operations Management Group, Indian Institute of Management Raipur, Abhanpur, India
| | - Yash Daultani
- Operations Management Group, Indian Institute of Management Lucknow, Lucknow, India
| | - Sanjoy Kumar Paul
- UTS Business School, University of Technology Sydney, Sydney, Australia
| | - Saurabh Pratap
- Department of Mechanical Engineering, Indian Institute of Technology (BHU), Varanasi, India
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3
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Fraser H, Tombe-Mdewa W, Kohli-Lynch C, Hofman K, Tempia S, McMorrow M, Lambach P, Ramkrishna W, Cohen C, Hutubessy R, Edoka I. Costs of seasonal influenza vaccination in South Africa. Influenza Other Respir Viruses 2022; 16:873-880. [PMID: 35355414 PMCID: PMC9343325 DOI: 10.1111/irv.12987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza accounts for a substantial number of deaths and hospitalisations annually in South Africa. To address this disease burden, the South African National Department of Health introduced a trivalent inactivated influenza vaccination programme in 2010. Methods We adapted and populated the WHO Seasonal Influenza Immunization Costing Tool (WHO SIICT) with country‐specific data to estimate the cost of the influenza vaccination programme in South Africa. Data were obtained through key‐informant interviews at different levels of the health system and through a review of existing secondary data sources. Costs were estimated from a public provider perspective and expressed in 2018 prices. We conducted scenario analyses to assess the impact of different levels of programme expansion and the use of quadrivalent vaccines on total programme costs. Results Total financial and economic costs were estimated at approximately USD 2.93 million and USD 7.91 million, respectively, while financial and economic cost per person immunised was estimated at USD 3.29 and USD 8.88, respectively. Expanding the programme by 5% and 10% increased economic cost per person immunised to USD 9.36 and USD 9.52 in the two scenarios, respectively. Finally, replacing trivalent inactivated influenza vaccine (TIV) with quadrivalent vaccine increased financial and economic costs to USD 4.89 and USD 10.48 per person immunised, respectively. Conclusion We adapted the WHO SIICT and provide estimates of the total costs of the seasonal influenza vaccination programme in South Africa. These estimates provide a basis for planning future programme expansion and may serve as inputs for cost‐effectiveness analyses of seasonal influenza vaccination programmes.
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Affiliation(s)
- Heather Fraser
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Winfrida Tombe-Mdewa
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,MassGenics, Duluth, Georgia, USA.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,US Public Health Service, Rockville, Maryland, USA
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, Pretoria, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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4
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Tucker A, Oyuku D, Nalugwa T, Nantale M, Ferguson O, Farr K, Reza TF, Shete PB, Cattamanchi A, Dowdy DW, Sohn H, Katamba A. Costs along the TB diagnostic pathway in Uganda. Int J Tuberc Lung Dis 2021; 25:61-63. [PMID: 33384046 DOI: 10.5588/ijtld.20.0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Oyuku
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - T Nalugwa
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - M Nantale
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - O Ferguson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Farr
- Implementation Science Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T F Reza
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - P B Shete
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - A Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - H Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Chatterjee S, Das P, Pinheiro A, Haldar P, Ray A, Brenzel L, Resch S. The incremental cost of improving immunization coverage in India through the Intensified Mission Indradhanush programme. Health Policy Plan 2021; 36:1316-1324. [PMID: 33950262 PMCID: PMC8428614 DOI: 10.1093/heapol/czab053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 11/12/2022] Open
Abstract
Intensified Mission Indradhanush (IMI) was a strategic endeavour launched by the Government of India aiming to achieve 90% full immunization coverage in the country by 2018. The basic strategy of this special drive involved identifying missed children and vaccinating them in temporary outreach sites for 1 week over consecutive 4-month period starting from October 2017. This study estimated the incremental economic and financial cost of conducting IMI in India from a government provider perspective. Five states—Assam, Bihar, Maharashtra, Rajasthan and Uttar Pradesh were purposefully selected because of high concentration of IMI activities. The stratified random sample of 40 districts, 90 sub-districts and 289 sub-centres were included in this study. Cost data were retrospectively collected at all levels from administrative records, financial records and staff interviews involved in IMI. The weighted incremental economic cost per dose (including vaccine costs) was lowest in Uttar Pradesh (US$3.45) and highest in Maharashtra (U$12.23). Incremental economic cost per IMI dose was found to be higher than a recent routine immunization costing study by Chatterjee and colleagues in 2018, suggesting that it requires additional resources to immunize children through an intensified push in hard-to-reach areas. Incremental financial cost of the IMI programme estimated in this study will be helpful for the government for any future planning of such special initiative. The reasons for variation of unit costs of IMI across the study districts are not known, but lower baseline coverage, high population density, migration, geography and terrain and vaccinating small numbers of children per session could account for the range of findings. Further analysis is required to understand the determinants of cost variations of the IMI programme, which may aid in better planning and more efficient use of resources for future intensified efforts.
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Affiliation(s)
- Susmita Chatterjee
- Research department, The George Institute for Global Health, Research Department, 308-309, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India.,Department of Medicine, University of New South Wales, 18 High Street, Kensington, New South Wales 2052, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Madhav Nagar, Manipal 576104, Karnataka, India
| | - Palash Das
- Research department, The George Institute for Global Health, Research Department, 308-309, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | - Anita Pinheiro
- Research department, The George Institute for Global Health, Research Department, 308-309, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India
| | - Pradeep Haldar
- Immunization Division, Ministry of Health and Family Welfare, Government of India, Nirman Bhawan, Maulana Azad Road, New Delhi 110011, India
| | - Arindam Ray
- The Bill & Melinda Gates Foundation, Capital Court, 5th Floor, Olof Palme Marg, Munirka, New Delhi 110067, India
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
| | - Stephen Resch
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, 718 Huntington Avenue, Boston MA 02115, USA
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Vaughan K, Clarke-Deelder E, Tani K, Lyimo D, Mphuru A, Manzi F, Schütte C, Ozaltin A. Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania. Vaccine 2020; 38:7659-7667. [PMID: 33077300 PMCID: PMC7604567 DOI: 10.1016/j.vaccine.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022]
Abstract
Delivery costs represent 33% of total immunization program costs in Tanzania. Costs are higher for outreach than for facility-based delivery. We used calibration methods to estimate unit and total costs. This work will inform domestic resource advocacy and planning.
Introduction Information on the costs of routine immunization programs is needed for budgeting, planning, and domestic resource mobilization. This information is particularly important for countries such as Tanzania that are preparing to transition out of support from Gavi, the Vaccine Alliance. This study aimed to estimate the total and unit costs for of child immunization in Tanzania from July 2016 to June 2017 and make this evidence available to key stakeholders. Methods We used an ingredients-based approach to collect routine immunization cost data from the facility, district, regional, and national levels. We collected data on the cost of vaccines as well as non-vaccine delivery costs. We estimated total and unit costs from a provider perspective for each level and overall, and examined how costs varied by delivery strategy, geographic area, and facility-level service delivery volume. An evidence-to-policy plan identified key opportunities and stakeholders to target to facilitate the use of results. Results The total annual economic cost of the immunization program, inclusive of vaccines, was estimated to be US$138 million (95% CI: 133, 144), or $4.32 ($3.72, $4.98) per dose. The delivery costs made up $45 million (38, 52), or $1.38 (1.06, 1.70) per dose. The costs of facility-based delivery were similar in urban and rural areas, but the costs of outreach delivery were higher in rural areas than in urban areas. The facility-level delivery cost per dose decreased with the facility service delivery volume. Discussion We estimated the costs of the routine immunization program in Tanzania, where no immunization costing study had been conducted for five years. These estimates can inform the program’s budgeting and planning as Tanzania prepares to transition out of Gavi support. Next steps for evidence-to-policy translation have been identified, including technical support requirements for policy advocacy and planning.
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Affiliation(s)
| | - Emma Clarke-Deelder
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
| | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Alex Mphuru
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
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7
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Bahuguna P, Guinness L, Sharma S, Chauhan AS, Downey L, Prinja S. Estimating the Unit Costs of Healthcare Service Delivery in India: Addressing Information Gaps for Price Setting and Health Technology Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:699-711. [PMID: 32170666 PMCID: PMC7519005 DOI: 10.1007/s40258-020-00566-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND India's flagship National Health insurance programme (AB-PMJAY) requires accurate cost information for evidence-based decision-making, strategic purchasing of health services and setting reimbursement rates. To address the challenge of limited health service cost data, this study used econometric methods to identify determinants of cost and estimate unit costs for each Indian state. METHODS Using data from 81 facilities in six states, models were developed for inpatient and outpatient services at primary and secondary level public health facilities. A best-fit unit cost function was identified using guided stepwise regression and combined with data on health service infrastructure and utilisation to predict state-level unit costs. RESULTS Health service utilisation had the greatest influence on unit cost, while number of beds, facility level and the state were also good predictors. For district hospitals, predicted cost per inpatient admission ranged from 1028 (313-3429) Indian Rupees (INR) to 4499 (1451-14,159) INR and cost per outpatient visit ranged from 91 (44-196) INR to 657 (339-1337) INR, across the states. For community healthcare centres and primary healthcare centres, cost per admission ranged from 412 (148-1151) INR to 3677 (1359-10,055) INR and cost per outpatient visit ranged from 96 (50-187) INR to 429 (217-844) INR. CONCLUSION This is the first time cost estimates for inpatient admissions and outpatient visits for all states have been estimated using standardised data. The model demonstrates the usefulness of such an approach in the Indian context to help inform health technology assessment, budgeting and forecasting, as well as differential pricing, and could be applied to similar country contexts where cost data are limited.
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Affiliation(s)
- Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Sameer Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Laura Downey
- International Decision Support Initiative, London, UK
- School of Public Health, Imperial College London, London, W2 1NY, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Portnoy A, Vaughan K, Clarke-Deelder E, Suharlim C, Resch SC, Brenzel L, Menzies NA. Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates. PHARMACOECONOMICS 2020; 38:995-1005. [PMID: 32596785 PMCID: PMC7437655 DOI: 10.1007/s40273-020-00930-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND To plan for the financial sustainability of immunization programs and make informed decisions to improve immunization coverage and equity, decision-makers need to know how much these programs cost beyond the cost of the vaccine. Non-vaccine delivery cost estimates can significantly influence the cost-effectiveness estimates used to allocate resources at the country level. However, many low- and middle-income countries (LMICs) do not have immunization delivery unit cost estimates available, or have estimates that are uncertain, unreliable, or old. We undertook a Bayesian evidence synthesis to generate country-level estimates of immunization delivery unit costs for LMICs. METHODS From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. A Bayesian meta-regression model was used to regress delivery cost per dose estimates, stratified by cost category, against a set of predictor variables including country-level [gross domestic product per capita, reported diphtheria-tetanus-pertussis third dose coverage (DTP3), population, and number of doses in the routine vaccination schedule] and study-level (study year, single antigen or programmatic cost per dose, and financial or economic cost) predictors. The fitted prediction model was used to generate standardized estimates of the routine immunization delivery cost per dose for each LMIC for 2009-2018. Alternative regression models were specified in sensitivity analyses. RESULTS We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64-4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26-1.70) for labor, $0.26 ($0.08-0.67) for supply chain, $0.22 ($0.06-0.57) for capital, and $0.65 ($0.20-1.66) for other service delivery costs. CONCLUSIONS Accurate immunization delivery costs are necessary for assessing the cost-effectiveness and strategic planning needs of immunization programs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.
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Affiliation(s)
- Allison Portnoy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue 2nd Floor, Boston, MA, 02115, USA.
| | | | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christian Suharlim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue 2nd Floor, Boston, MA, 02115, USA
- Management Sciences for Health, Boston, MA, USA
| | - Stephen C Resch
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue 2nd Floor, Boston, MA, 02115, USA
| | | | - Nicolas A Menzies
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue 2nd Floor, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Vyas S, Songo J, Guinness L, Dube A, Geis S, Kalua T, Todd J, Renju J, Crampin A, Wringe A. Assessing the costs and efficiency of HIV testing and treatment services in rural Malawi: implications for future "test and start" strategies. BMC Health Serv Res 2020; 20:740. [PMID: 32787835 PMCID: PMC7422472 DOI: 10.1186/s12913-020-05446-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reaching the 90-90-90 targets requires efficient resource use to deliver HIV testing and treatment services. We investigated the costs and efficiency of HIV services in relation to HIV testing yield in rural Karonga District, Malawi. METHODS Costs of HIV services were measured over 12 months to September 2017 in five health facilities, drawing on recognised health costing principles. Financial and economic costs were collected in Malawi Kwacha and United States Dollars (US$). Costs were calculated using a provider perspective to estimate average annual costs (2017 US$) per HIV testing episode, per HIV-positive case diagnosed, and per patient-year on antiretroviral therapy (ART), by facility. Costs were assessed in relation to scale of operation and facility-level annual HIV positivity rate. A one-way sensitivity analysis was undertaken to understand how staffing levels and the HIV positivity rate affected HIV testing costs. RESULTS HIV testing episodes per day and per full-time equivalent HIV health worker averaged 3.3 (range 2.0 to 5.7). The HIV positivity rate averaged 2.4% (range 1.9 to 3.7%). The average cost per testing episode was US$2.85 (range US$1.95 to US$8.55), and the average cost per HIV diagnosis was US$116.35 (range US$77.42 to US$234.11), with the highest costs found in facilities with the lowest daily number of tests and lowest HIV yield respectively. The mean facility-level cost per patient-year on ART was approximately US$100 (range US$90.67 to US$115.42). ART drugs were the largest cost component averaging 71% (range 55 to 76%). The cost per patient-year of viral load tests averaged US$4.50 (range US$0.52 to US$7.00) with cost variation reflecting differences in the tests to ART patient ratio across facilities. CONCLUSION Greater efficiencies in HIV service delivery are possible in Karonga through increasing daily testing episodes among existing health workers or allocating health workers to tasks in addition to testing. Costs per diagnosis will increase as yields decline, and therefore, encouraging targeted testing strategies that increase yield will be more efficient. Given the contribution of drug costs to per patient-year treatment costs, it is critical to preserve the life-span of first-line ART regimens, underlining the need for continuing adherence support and regular viral load monitoring.
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Affiliation(s)
- Seema Vyas
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Steffen Geis
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Institute of Medical Microbiology and Hygiene, Philipps University Margburg, Marburg, Germany
| | - Thokozani Kalua
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Amelia Crampin
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Vaughan K, Ozaltin A, Moi F, Kou Griffiths U, Mallow M, Brenzel L. Reporting gaps in immunization costing studies: Recommendations for improving the practice. Vaccine X 2020; 5:100069. [PMID: 32875287 PMCID: PMC7451807 DOI: 10.1016/j.jvacx.2020.100069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022] Open
Abstract
Poor practices and reporting oversights limit the understanding and use of immunization cost data. Our review identified reporting problems on the vaccines costed, types of costs, and data analysis. Our checklist offers a standard of practice for reporting on immunization costing studies. Reporting that adheres to this checklist will increase the interpretability and use of evidence.
High-quality evidence on the cost of delivering vaccines is essential for policymakers, planners, and donors to ensure sufficient, equitable, predictable, and sustainable financing. However, poor practices and reporting oversights in both the published and grey literature limit the understanding and usability of cost data. This paper describes quality assessment results and quantifies problems with immunization costing study reporting practices found in 68 articles and reports included in an immunization delivery unit cost repository focused on low- and middle-income countries and launched in 2018, the Immunization Delivery Cost Catalogue (IDCC). We recommend a standard of practice for writing up an immunization costing study, in the form of an easy to follow checklist, to increase the quality of reporting and the comparability of results. Reporting that adheres to this checklist will improve the comprehension and interpretability of evidence, increasing the likelihood that costing studies are understood and can be used for resource mobilization and allocation, planning and budgeting, and policy decisions.
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Affiliation(s)
| | - Annette Ozaltin
- ThinkWell, Washington, DC, USA
- Corresponding author at: ThinkWell, 1875 Connecticut Avenue, 10 Floor, Washington, DC 20009, USA.
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Falcón-Lezama JA, Saucedo-Martínez R, Betancourt-Cravioto M, Alfaro-Cortes MM, Bahena-González RI, Tapia-Conyer R. Influenza in the school-aged population in Mexico: burden of disease and cost-effectiveness of vaccination in children. BMC Infect Dis 2020; 20:240. [PMID: 32197591 PMCID: PMC7085158 DOI: 10.1186/s12879-020-4948-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population (5-11 years). Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population. METHODS A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. We performed a cross-sectional epidemiological study using influenza records (2009-2018), death records (2010-2015), and discharge and hospitalisation records (2010-2016), from the databases of Mexico's Influenza Surveillance System (SISVEFLU), the National Mortality Epidemiological and Statistical System (SEED), and the Automated Hospital Discharge System (SAEH), respectively. Cost estimates for influenza cases were based on 7 scenarios using data analysed from SISVEFLU; assumptions for clinical management of cases were defined according to Mexico's national clinical guidelines. The primary health outcome for this study was the number of influenza cases avoided. A sensitivity analysis was performed using conservative and optimistic parameters (vaccination coverage: 30% / 70%, Vaccine effectiveness: 19% / 68%). RESULTS It was estimated that expanding the influenza immunisation programme to cover school-aged population in Mexico over the 2018-2019 influenza season would result in 671,461 cases of influenza avoided (50% coverage and 50% effectiveness assumed). Associated with this were 262,800 fewer outpatient consultations; 154,100 fewer emergency room consultations; 97,600 fewer hospitalisations, and 15 fewer deaths. Analysis of cases avoided by age-group showed that 55.4% of them were in the school-aged population, and the decrease in outpatient consultations was largest in this population. There was an overall decrease in the economic burden for the Mexican health care system of 111.9 million US dollars; the immunization programme was determined to be cost-saving in the base, conservative and optimistic scenarios. CONCLUSIONS Vaccinating school-aged population in Mexico would be cost-effective; expansion of the current national vaccination schedule to this age group is supported.
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Affiliation(s)
| | - Rodrigo Saucedo-Martínez
- Sociedad Mexicana de Salud Pública, Herschel 109, Anzures, Miguel Hidalgo, 11590, Mexico City, Mexico
| | | | - Myrna María Alfaro-Cortes
- Sociedad Mexicana de Salud Pública, Herschel 109, Anzures, Miguel Hidalgo, 11590, Mexico City, Mexico
| | | | - Roberto Tapia-Conyer
- Sociedad Mexicana de Salud Pública, Herschel 109, Anzures, Miguel Hidalgo, 11590, Mexico City, Mexico.
- Universidad Nacional Autónoma de México, Av. Universidad 3000, Circuito Escolar CU, Edificio B 1er Piso, Coyoacan, 04510, Mexico City, Mexico.
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