HealthEconomicsWorkshop:

CostingToolsMonishaSharma,PhD

InternationalClinicalResearchCenter(ICRC)UniversityofWashington

Reminder:usesofcostdata

Resourcerequirementsandadvocacy

Prioritysettingfornewinterventionsorintroducingnew

technologies,drugs,vaccines

Financialplanningandbudgeting/information

onsustainability

Economicevaluation/Improvingtechnicalefficiency

• Budgetplanning: Governmentsandlocalhealthagenciescanusetoolstohelpinplanningandbudgetingprocesses• Decisionmaking:Targetcoverage,eg 50%ofHIVpositivepersonsonARTorimpactguided:30%reductioninHIVincidence.

• Costinginterventionsandhealthoutcomes:Determiningthecostsandeffectiveness(e.g.deathordiseaseaverted)associatedwithdifferentinterventions.Conductingacost-effectivenessanaylsis

Usesofcostingtools

• Provideinformationonthecostofscalingupandsustaininghealthprogramsatdifferentlevelsofthehealthsystem(andevenforglobalprograms)• Aimtoinformdecisionmakingandprogrammingtoachievespecificgoals(i.e.sustainabledevelopmentgoals)• Helpevaluateprogresstowardshealthtargets,egMillenniumdevelopmentgoals:17healthgoalstobemetoverthenext15years.

Costingtoolscan:

•Determine:• Costofscaleuppackageofinterventions•Costofachievingtargetcoverage•Costofstrategicmulti-yearplan• Impactofresourceallocationonanoutcome

Focusoftools:

• Mostofthetoolsaredesignedtobeusedafterformaltraining• Althoughitispossibletodownloadandlearnthetoolsonyourown

• It’sdifficulttounderstandhowthetoolsoperate(blackboxes).Evenwithuserguidesthecomputationsarenotclearlyoutlined• MostareExcel-based• Usetheingredients/bottom-upcosting• Eachtoolusesadifferentapproachanddifferentlogic.Optimaltooldependsonresearchquestionandavailabledata.

Characteristicsofcostingtools

• Costtoolsusetwobasicproductionfunctions• Interventionproductionfunction:Calculatedbymultiplyingthepriceofaninput(eg unitcostofcondom)timesthequantityofinputsused(#ofcondomsdistributed• Cost*Quantity

• Healthproductionfunction: Calculatedbymultiplyingthenumberofpersonsservedbyaninterventiontimestheeffectivenessoftheintervention(eg #ofadultsservedbynutritionalinterventiontimeseffectivenessofinterventioninreducingmalnutrition.• Coverage*effectiveness

Howdothetoolscalculatecostandimpact?

• ChildhealthinterventioninvolvingdistributingvitaminAtochildrenusingcommunityhealthworkersathealthfairswiththegoalofreducing<5mortality

• Healthproductionfunction:#ofchildrenserved*effectivenessinreducing<5mortality• Costproductionfunction:Unitcostof2vitaminAcapsules*#childrenreached+#healthworkersneeded*#ofdaystheywork*dailypayrate+costofeachcommunityawarenesscampaign*#ofcampaigns

E.g.VitaminAsupplementationprogram

• Mosttoolsarepre-populatedwithcostsfordifferenthealthinterventions,countrydemographics,interventioneffectiveness• Somedataarebetterthanothers—itsimportanttocheckthemodelassumptionsandmakesuretheyareaccurateforyouranalysis.Manyparametersneedtobereplacedtorepresentcontextofyouranalysis.

Datarequirementsfortools

Selectionofcostingtools

• DecisionMakersProgramPlanningTool(DMPPT)• ReproductiveHealth(RH)CostingTool• IntegratedHealthcareTechnologyPackage(iHTP)

SimulationTool• Spectrum:PMTCTCostEffectiveness• GoalsModel• Planning,CostingandBudgetingFramework(PCBF)• COREPlus• IntegratedHealthModel• Planning&BudgetingforTBControl• ResourceNeedsModelHIV/AIDS• OneHealthModel(synthesisofallmodelingtools)

DecisionMakersProgramPlanningTool(DMPPT)developedbyUNAIDS

• Excel-basedmodelthatcanestimatecostsandeffectiveness(infectionsaverted)associatedwithdifferentscenariosofmalecircumcision(MC)scale-up.

• Scenarioscanvary:• Prioritypopulations:allmales,youngadults,newborns,ormost-at-riskgroups• Coveragelevelsandscale-uprates• Servicedeliverymodes:hospital,clinic,mobilevan;public,private,NGO• SurgicaltechniqueusedforMC,kitused• Taskshifting,tasksharing• Riskcompensation• Maleà FemaletransmissionreductionwithMC• Populationage-structure,birthandmortalityrate• Sexualbehavior• Discounting

Decision Makers Program Planning Tool

Results:CostsofscalingupVMCto80%bycountry

ExampleofanalysisconductedwithDMPPT

Example:GoalsTool

• UsedtoestimatethecosteffectivenessofscalingupHIVself-testingin3developingcountries

Example:SpectrumModel

Deathsaverted

Infectionsaverted

DALYSaverted

DeathsavertedinHanoi(possiblebug)

Choosingtherighttool:SummaryofcostingtoolsavailablethruWHO

Choosingtherighttool

ChildHealth HIV/AIDS/TB/Malaria Reproductivehealth

General

Child HealthCostEstimationtoolCHCET

GoalsModel HIV/AIDS ReproductiveHealthCostingTool

CostRevenueAnalysisToolPlus(COREplus

cMYP-ComprehensivemultiyearplanImmunization

Malaria costestimationtool

Integrated HealthcareTechnologyPackage(iHTP)

Planning&BudgetingforTBControl

IntegratedHealthModel(IHM)

ResourceneedsModelHIV/AIDS

MarginalBudgetingforBottlenecks(MBB)

Spectrum PMTCTCE Planning,costingandbudgetingframework(PCBF)

OptimizeHIV/AIDS OneHealth

Categoriestoolsbyhealthintervention

• Coverageguideddecisionmakingwithbudgetconstraint• Impactguideddecisionmakingwithbudgetconstraint• Short-term1year• Mediumtermfocus(1-10years)• Longtermfocus(10+years)• Mostmeasurequantitiesandpricesassociatedwithactivities

Methodsused?

• Averagecostperintervention• Totalcost• Scaleupcost• Fundinggap• Resourcebottleneck• Coverage• Impactonhealthoutcome• Budget• Summarytableofcostsand/orbenefits• Graphs

Typesofoutputsfromthesetools

Otheranalysesconductedwithcostingtools

Toolsusedby:WHO,UNAIDSCommissions,eg LancetcommissiononGlobalHealth2035whichestimatedcosttoscaleupinterventionstolowermortalityratesindevelopingcountries.Thismaybeacademicorresearchorganizationswhodothework.Nationalgovernmentsusetoolsintheirhealthsectorstrategicplanning—eitherMOHstafforconsultants

• WHOGuidesummarizingavailablecostingtools:http://www.who.int/pmnch/knowledge/publications/costing_tools/en/

msharma1@uw.edu

THANKYOU