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Morozoff C, Ahmed N, Chinkhumba J, Islam MT, Jallow AF, Ogwel B, Zegarra Paredes LF, Sanogo D, Atlas HE, Badji H, Bar-Zeev N, Conteh B, Güimack Fajardo M, Feutz E, Haidara FC, Karim M, Mamby Keita A, Keita Y, Khanam F, Kosek MN, Kotloff KL, Maguire R, Mbutuka IS, Ndalama M, Ochieng JB, Okello C, Omore R, Perez Garcia KF, Qamar FN, Qudrat-E-Khuda S, Qureshi S, Rajib MNH, Shapiama Lopez WV, Sultana S, Witte D, Yousafzai MT, Awuor AO, Cunliffe NA, Jahangir Hossain M, Paredes Olortegui M, Tapia MD, Zaman K, Means AR. Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study. Open Forum Infect Dis 2024; 11:S41-S47. [PMID: 38532961 PMCID: PMC10962725 DOI: 10.1093/ofid/ofad575] [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] [Indexed: 03/28/2024] Open
Abstract
Background Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children. Methods EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios. Conclusions Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.
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Affiliation(s)
- Chloe Morozoff
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Naveed Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jobiba Chinkhumba
- School of Global and Public Health, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Abdoulie F Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | | | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Henry Badji
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bakary Conteh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fadima C Haidara
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Mehrab Karim
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Youssouf Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Maguire
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - John Benjamin Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Collins Okello
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | | | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Qudrat-E-Khuda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Md Nazmul Hasan Rajib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | | | - Shazia Sultana
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Desiree Witte
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - K Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Chauhan AS, Guinness L, Bahuguna P, Singh MP, Aggarwal V, Rajsekhar K, Tripathi S, Prinja S. Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment. BMC Health Serv Res 2022; 22:1343. [PMCID: PMC9664599 DOI: 10.1186/s12913-022-08707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
AbstractThe 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors.A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location.The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification).The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.
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Brundisini F, Zomahoun HTV, Légaré F, Rhéault N, Bernard-Uwizeye C, Massougbodji J, Gogovor A, Tchoubi S, Assan O, Laberge M. Economic evaluations of scaling up strategies of evidence-based health interventions: a systematic review protocol. BMJ Open 2021; 11:e050838. [PMID: 34593499 PMCID: PMC8487175 DOI: 10.1136/bmjopen-2021-050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Scaling science aims to help roll out evidence-based research results on a wide scale to benefit more individuals. Yet, little is known on how to evaluate economic aspects of scaling up strategies of evidence-based health interventions. METHODS AND ANALYSIS Using the Joanna Briggs Institute guidance on systematic reviews, we will conduct a systematic review of characteristics and methods applied in economic evaluations in scaling up strategies. To be eligible for inclusion, studies must include a scaling up strategy of an evidence-based health intervention delivered and received by any individual or organisation in any country and setting. They must report costs and cost-effectiveness outcomes. We will consider full or partial economic evaluations, modelling and methodological studies. We searched peer-reviewed publications in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception onwards. We will search grey literature from international organisations, bilateral agencies, non-governmental organisations, consultancy firms websites and region-specific databases. Two independent reviewers will screen the records against the eligibility criteria and extract data using a pretested extraction form. We will extract data on study characteristics, scaling up strategies, economic evaluation methods and their components. We will appraise the methodological quality of included studies using the BMJ Checklist. We will narratively summarise the studies' descriptive characteristics, methodological strengths/weaknesses and the main drivers of cost-effectiveness outcomes. This study will help identify what are the trade-offs of scaling up evidence-based interventions to allocate resources efficiently. ETHICS AND DISSEMINATION No ethics approval is required as no primary data will be collected. The results will be published in a peer-reviewed, international journal and presented at national and international conferences.
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Affiliation(s)
- Francesca Brundisini
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Operations and Decision Systems, Université Laval, Quebec, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Nathalie Rhéault
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Claude Bernard-Uwizeye
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
| | - José Massougbodji
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Amédé Gogovor
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sébastien Tchoubi
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Odilon Assan
- Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
- Pharmacy, Université Laval, Quebec, Quebec, Canada
| | - Maude Laberge
- Operations and Decision Systems, Université Laval, Quebec, Quebec, Canada
- VITAM, Centre de recherche en santé durable -Université Laval, CIUSSS de la Capitale-Nationale, Quebec, Quebec, Canada
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Hellebo AG, Zuhlke LJ, Watkins DA, Alaba O. Health system costs of rheumatic heart disease care in South Africa. BMC Public Health 2021; 21:1303. [PMID: 34217236 PMCID: PMC8254987 DOI: 10.1186/s12889-021-11314-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa. METHODS The primary data on service utilisation were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study) - a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from a health system perspective were estimated in 2017 (base year) in South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (USD). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. A 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis. RESULTS The estimated total cost of RHD care at the tertiary hospital was USD 2 million (in 2017 USD) for the year 2017, with surgery costs accounting for 65%. Per-patient, average annual costs were USD 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterisation and heart valve surgery were the main cost drivers. CONCLUSIONS RHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programmes at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.
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Affiliation(s)
- Assegid G Hellebo
- Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Liesl J Zuhlke
- Division of Paediatric Cardiology, Department of Paediatrics, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David A Watkins
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, USA.,Department of Global Health, University of Washington, Seattle, USA
| | - Olufunke Alaba
- Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Tortorella GL, Fogliatto FS, Espôsto KF, Mac Cawley AF, Vassolo R, Tlapa D, Narayanamurthy G. Healthcare costs’ reduction through the integration of Healthcare 4.0 technologies in developing economies. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2020.1861934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Guilherme Luz Tortorella
- School of Engineering, University of Melbourne Faculty of Science, Victoria, Australia
- Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Flavio Sanson Fogliatto
- Department of Industrial Engineering, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Alejandro Francisco Mac Cawley
- Pontificia Universidad Catolica de Chile, Industrial and Systems Engineering, Macul, Chile
- Pontificia Universidad Católica de Chile, Agricultural Economics, Santiago, Chile
| | | | - Diego Tlapa
- Universidad Autonoma de Baja California - Campus Ensenada, Ensenada, Mexico
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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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Stenberg K, Lauer JA, Gkountouras G, Fitzpatrick C, Stanciole A. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:11. [PMID: 29559855 PMCID: PMC5858135 DOI: 10.1186/s12962-018-0095-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/28/2018] [Indexed: 12/30/2022] Open
Abstract
Background Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Methods Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. Results Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. Conclusions These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.
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Affiliation(s)
- Karin Stenberg
- 1Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Jeremy A Lauer
- 1Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | | | - Anderson Stanciole
- United Nations Population Fund, Asia and Pacific Regional Office, Bangkok, Thailand
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Cunnama L, Sinanovic E, Ramma L, Foster N, Berrie L, Stevens W, Molapo S, Marokane P, McCarthy K, Churchyard G, Vassall A. Using Top-down and Bottom-up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale. HEALTH ECONOMICS 2016; 25 Suppl 1:53-66. [PMID: 26763594 PMCID: PMC5066665 DOI: 10.1002/hec.3295] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 10/27/2015] [Accepted: 11/05/2015] [Indexed: 05/06/2023]
Abstract
PURPOSE Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. MATERIALS AND METHODS We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. RESULTS The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. CONCLUSION Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.
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Affiliation(s)
- Lucy Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lebogang Ramma
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicola Foster
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh Berrie
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Wendy Stevens
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Sebaka Molapo
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Puleng Marokane
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | | | - Gavin Churchyard
- Aurum Institute for Health Research, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Portnoy A, Jit M, Lauer J, Blommaert A, Ozawa S, Stack M, Murray J, Hutubessy R. Estimating costs of care for meningitis infections in low- and middle-income countries. Vaccine 2016; 33 Suppl 1:A240-7. [PMID: 25919168 DOI: 10.1016/j.vaccine.2014.11.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/22/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
Meningitis infections are often associated with high mortality and risk of sequelae. The costs of treatment and care for meningitis are a great burden on health care systems, particularly in resource-limited settings. The objective of this study is to review data on the costs of care for meningitis in low- and middle-income countries, as well as to show how results could be extrapolated to countries without sound data. We conducted a systematic review of the literature from six databases to identify studies examining the cost of care in low- and middle-income countries for all age groups with suspected, probable, or confirmed meningitis. We extracted data on treatment costs and sequelae by infectious agent and/or pathogen, where possible. Using multiple regression analysis, a relationship between hospital costs and associated determinants was investigated in order to predict costs in countries with missing data. This relationship was used to predict treatment costs for all 144 low- and middle-income countries. The methodology of conducting a systematic review, extrapolating, and setting up a standard database can be used as a tool to inform cost-effectiveness analyses in situations where cost of care data are poor. Both acute and long-term costs of meningitis could be extrapolated to countries without reliable data. Although only bacterial causes of meningitis can be vaccine-preventable, a better understanding of the treatment costs for meningitis is crucial for low- and middle-income countries to assess the cost-effectiveness of proposed interventions in their country. This cost information will be important as inputs in future cost-effectiveness studies, particularly for vaccines.
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Affiliation(s)
- Allison Portnoy
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Modelling and Economics Unit, Public Health England, London NW9 5EQ, United Kingdom.
| | - Jeremy Lauer
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | - Adriaan Blommaert
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken Lokaal D.R.212, 2610 Wilrijk, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Campus Diepenbeek Agoralaan Gebouw D; BE 3590, Diepenbeek, Belgium.
| | - Sachiko Ozawa
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Meghan Stack
- Independent Consultant, 2417 Panama Street, Philadelphia, PA 19103, USA.
| | - Jillian Murray
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, MD, USA.
| | - Raymond Hutubessy
- World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. PLoS One 2014; 9:e91781. [PMID: 24626285 PMCID: PMC3953597 DOI: 10.1371/journal.pone.0091781] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India's policy of introducing a second auxiliary nurse midwife (ANM) at the sub-centre compared to scenario of single ANM sub-centre. METHODS We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants. RESULTS Annually it costs INR 1.03 million (USD 19,381), or INR 187 (USD 3.5) per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10) per full ANC care, INR 767 (USD 14) per PNC case registered, INR 974 (USD 18) per DOTS treatment completed and INR 97 (USD 1.8) per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432). CONCLUSION Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India's policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective.
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Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. BMC Health Serv Res 2014; 14:96. [PMID: 24581003 PMCID: PMC3944798 DOI: 10.1186/1472-6963-14-96] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 02/18/2014] [Indexed: 11/11/2022] Open
Abstract
Background Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. Methods This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. Results The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Conclusions Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.
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Marschall P, Flessa S. Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis. HEALTH ECONOMICS REVIEW 2011; 1:5. [PMID: 22828358 PMCID: PMC3395044 DOI: 10.1186/2191-1991-1-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 07/20/2011] [Indexed: 05/28/2023]
Abstract
BACKGROUND Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. OBJECTIVE This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. METHODOLOGY We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. RESULTS The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution CONCLUSIONS Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care.
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Affiliation(s)
- Paul Marschall
- University of Greifswald, Faculty of Law and Economics, Department of Health Care Management, Friedrich-Loeffler-Str. 70, D-17489 Greifswald, Germany
| | - Steffen Flessa
- University of Greifswald, Faculty of Law and Economics, Department of Health Care Management, Friedrich-Loeffler-Str. 70, D-17489 Greifswald, Germany
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Costs of post-abortion care in low- and middle-income countries. Int J Gynaecol Obstet 2009; 108:165-9. [PMID: 20035938 DOI: 10.1016/j.ijgo.2009.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 08/20/2009] [Accepted: 10/15/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the quality of costing studies of post-abortion care from low- and middle-income countries and to describe costs in various settings. METHODS A systematic review identified unit costs. Descriptive statistical analysis and univariate regression analysis identified drivers of unit costs of post-abortion care. RESULTS There are few cost studies from Asia or Eastern Europe. Data indicate that the cost (in 2007 international dollars) of post-abortion care in Africa and Latin America is $392 and $430, respectively, per case. CONCLUSION Differences in post-abortion care costs were associated with region, procedure, facility level, case severity, and whether the study was operations research. Methods varied between studies, and efforts should be made in future research to improve consistency. Additional data are needed from Asia and Eastern Europe, as well as the costs of medical methods of uterine evacuation. These data justify improved access to contraception and safe, legal abortion.
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