Moving away from the 'unit cost'. Predicting country-specific average cost curves of VMMC services accounting for variations in service delivery platforms in sub-Saharan Africa

Autor: Lily Alexander, Carol Levin, Anna Vassall, Steven Forsythe, Gabriela B. Gomez, Carlos Pineda-Antunez, William H. Dow, James G. Kahn, Michel Tchuenche, Chris Chiwevu, Sergio Bautista-Arredondo, Drew B. Cameron, Diego Cerecero-Garcia, Lori Bollinger
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
RNA viruses
Cost estimate
Epidemiology
Economics
Service delivery framework
Computer science
Extrapolation
Social Sciences
Pathology and Laboratory Medicine
Global Health
Geographical Locations
0302 clinical medicine
Immunodeficiency Viruses
Circumcision
Medicine and Health Sciences
Salaries
Public and Occupational Health
Uganda
030212 general & internal medicine
Reproductive System Procedures
Average cost
Numerical Analysis
Multidisciplinary
HIV epidemiology
Medical Microbiology
Cost driver
Viral Pathogens
Scale (social sciences)
Physical Sciences
Viruses
Costs and Cost Analysis
Medicine
Pathogens
0305 other medical science
Research Article
Science
Surgical and Invasive Medical Procedures
Accounting
Microbiology
Unit (housing)
03 medical and health sciences
Retroviruses
Humans
Unit cost
Microbial Pathogens
Africa South of the Sahara
030505 public health
business.industry
Lentivirus
Organisms
Biology and Life Sciences
HIV
Economies of scale
Health Care
Circumcision
Male
Health Care Facilities
Labor Economics
People and Places
Africa
business
Delivery of Health Care
Facilities and Services Utilization
Mathematics
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 4, p e0249076 (2021)
ISSN: 1932-6203
Popis: Background One critical element to optimize funding decisions involves the cost and efficiency implications of implementing alternative program components and configurations. Program planners, policy makers and funders alike are in need of relevant, strategic data and analyses to help them plan and implement effective and efficient programs. Contrary to widely accepted conceptions in both policy and academic arenas, average costs per service (so-called "unit costs") vary considerably across implementation settings and facilities. The objective of this work is twofold: 1) to estimate the variation of VMMC unit costs across service delivery platforms (SDP) in Sub-Saharan countries, and 2) to develop and validate a strategy to extrapolate unit costs to settings for which no data exists. Methods We identified high-quality VMMC cost studies through a literature review. Authors were contacted to request the facility-level datasets (primary data) underlying their results. We standardized the disparate datasets into an aggregated database which included 228 facilities in eight countries. We estimated multivariate models to assess the correlation between VMMC unit costs and scale, while simultaneously accounting for the influence of the SDP (which we defined as all possible combinations of type of facility, ownership, urbanicity, and country), on the unit cost variation. We defined SDP as any combination of such four characteristics. Finally, we extrapolated VMMC unit costs for all SDPs in 13 countries, including those not contained in our dataset. Results The average unit cost was 73 USD (IQR: 28.3, 100.7). South Africa showed the highest within-country cost variation, as well as the highest mean unit cost (135 USD). Uganda and Namibia had minimal within-country cost variation, and Uganda had the lowest mean VMMC unit cost (22 USD). Our results showed evidence consistent with economies of scale. Private ownership and Hospitals were significant determinants of higher unit costs. By identifying key cost drivers, including country- and facility-level characteristics, as well as the effects of scale we developed econometric models to estimate unit cost curves for VMMC services in a variety of clinical and geographical settings. Conclusion While our study did not produce new empirical data, our results did increase by a tenfold the availability of unit costs estimates for 128 SDPs in 14 priority countries for VMMC. It is to our knowledge, the most comprehensive analysis of VMMC unit costs to date. Furthermore, we provide a proof of concept of the ability to generate predictive cost estimates for settings where empirical data does not exist.
Databáze: OpenAIRE
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