scholarly journals Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

2020 ◽  
Vol 38 (9) ◽  
pp. 995-1005 ◽  
Author(s):  
Allison Portnoy ◽  
Kelsey Vaughan ◽  
Emma Clarke-Deelder ◽  
Christian Suharlim ◽  
Stephen C. Resch ◽  
...  
Keyword(s):  
Unit Cost ◽  
Economic Cost ◽  
Cost Category ◽  
Delivery Cost ◽  
Cost Estimates ◽  
Country Level ◽  
Delivery Costs ◽  
Delivery Unit ◽  
Childhood Vaccines ◽  
The Cost

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.

At what cost is performance-based financing implemented? Novel evidence from Malawi

2019 ◽  
Vol 34 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Manuela De Allegri ◽  
Chris Makwero ◽  
Aleksandra Torbica
Keyword(s):  
Low Income ◽  
Economic Cost ◽  
Personnel Cost ◽  
Cost Category ◽  
Implementation Phase ◽  
Personnel Costs ◽  
Performance Based Financing ◽  
Implementation Costs ◽  
The Cost ◽  
Low Income Setting

Abstract Our study estimated the full economic cost of implementing performance-based financing [PBF, the Support for Service Delivery Integration Performance-Based Incentives (SSDI-PBI) programme], as a means of first introducing strategic purchasing in a low-income setting, Malawi. Our analysis distinguished design from implementation costs and traces costs across personnel and non-personnel cost categories over the 2012–15 period. The full cost of the SSDI-PBI programme amounted to USD 3 402 187, equivalent to USD 6.46 per targeted beneficiary. The design phase accounted for about one-third (USD 1 161 332) of the total costs, while the incentives (USD 1 140 436) represented about one-third of the total cost of the intervention and about half the cost of the implementation phase. With a cost of USD 1 605 178, personnel costs represented the dominant cost category. Our study indicated that the introduction of PBF entailed consumption of a substantial amount of resources, hence representing an important opportunity cost for the health system.

scholarly journals A Review of Cost Estimates for Flood Adaptation

Water ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1646 ◽  
Author(s):  
Jeroen Aerts
Keyword(s):  
Unit Cost ◽  
Economic Assessment ◽  
Costs And Benefits ◽  
Construction Costs ◽  
Cost Information ◽  
Adaptation Measures ◽  
Cost Estimates ◽  
The Cost ◽  
Riverine Systems ◽  
Flood Adaptation

Floods are the most devastating of global natural disasters, and flood adaptation measures are needed to reduce future risk. Researchers have started to evaluate the costs and benefits of flood adaptation, but information regarding the cost of different flood adaptation measures is often not available or is hidden in non-peer-reviewed literature. Recent review studies have explored cost estimates for different aspects of flood adaptation, such as nature-based solutions. This study aims to contribute empirical data regarding the cost of flood adaptation by compiling peer-reviewed literature and research reports. The focus is on construction costs and expenses for operation and maintenance. This paper integrates the unit cost information of six main flood adaptation measure categories: (1) the flood-proofing of buildings, (2) flood protection, (3) beach nourishment and dunes, (4) nature-based solutions for coastal ecosystems, (5) channel management and nature-based solutions for riverine systems, and (6) urban drainage. Cost estimates are corrected for inflation and converted to U.S. dollars (2016). Measures are described, and cost figures for both developed and developing countries are provided. The results of this study can be used as input for economic-assessment studies on flood adaptation measures.

The Cost of Being ‘Backward’ in India: Socio-religious Discrimination in the Labour Market

2021 ◽  
pp. 097370302110296
Author(s):  
Soumyajit Chakraborty ◽  
Alok K. Bohara
Keyword(s):  
Labour Market ◽  
Economic Cost ◽  
National Sample ◽  
Sample Survey ◽  
Religious Discrimination ◽  
Capital Endowment ◽  
Scheduled Castes ◽  
Sample Survey Data ◽  
The Cost ◽  
Human Capital Endowment

Being from backward castes, classes and Muslims in India has an economic cost associated with the nature of institutional discrimination. Using the 2011–2012 National Sample Survey data, this study identifies that caste and religion still rule the modern Indian labour market. We find that discrimination is evident in the socio-religious earnings gaps. While the parametric decompositions suggest that most of these gaps are due to differential human capital endowment, the nonparametric method almost evenly attributes inequality to discrimination and endowment. The results presented in this study suggest that discrimination against Scheduled Castes and Scheduled Tribes, Muslims and Other Backward Classes should be included in policy designs to promote equity in the Indian labour market.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

scholarly journals Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shwe Sin Kyaw ◽  
Gilles Delmas ◽  
Tom L. Drake ◽  
Olivier Celhay ◽  
Wirichada Pan-ngum ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Unit Cost ◽  
Financial Data ◽  
Research Activities ◽  
High Incidence ◽  
Implementation Costs ◽  
The Cost ◽  
Greater Mekong Subregion

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses. Results The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5. Conclusion This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.

scholarly journals A cost analysis to address issues of budget constraints on the implementation of the indoor residual spray programme in two districts of Maputo Province, Mozambique

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Neide Canana
Keyword(s):  
Sensitivity Analysis ◽  
Cost Analysis ◽  
Financial Analysis ◽  
Indoor Residual Spraying ◽  
Economic Cost ◽  
Cost Information ◽  
Financial Cost ◽  
Provider Perspective ◽  
The Government ◽  
The Cost

Abstract Background It is frequently said that funding is essential to ensure optimal results from a malaria intervention control. However, in recent years, the capacity of the government of Mozambique to sustain the operational cost of indoor residual spraying (IRS) is facing numerous challenges due to restrictions of the Official Development Assistance. The purpose of the study was to estimate the cost of IRS operationalization in two districts of Maputo Province (Matutuíne and Namaacha) in Mozambique. The evidence produced in this study intends to provide decision-makers with insight into where they need to pay close attention in future planning in order to operationalize IRS with the existent budget in the actual context of budget restrictions. Methods Cost information was collected retrospectively from the provider perspective, and both economic and financial costs were calculated. A “one-way” deterministic sensitivity analysis was performed. Results The average economic costs totaled US$117,351.34, with an average economic cost per household sprayed of US$16.35, and an average economic cost per person protected of US$4.09. The average financial cost totaled US$69,174.83, with an average financial cost per household sprayed and per person protected of US$9.84 and US$2.46, respectively. Vehicle, salary, and insecticide costs were the greatest contributors to overall cost in the economic and financial analysis, corresponding to 52%, 17%, and 13% in the economic analysis and 21%, 27%, and 22% in the financial analysis, respectively. The sensitivity analysis was adapted to a range of ± (above and under) 25% change. There was an approximate change of 14% in the average economic cost when vehicle costs were decreased by 25%. In the financial analysis, the average financial cost was lowered by 7% when salary costs were decreased by 25%. Conclusions Altogether, the current cost analysis provides an impetus for the consideration of targeted IRS operationalization within the available governmental budget, by using locally-available human resources as spray operators to decrease costs and having IRS rounds be correctly timed to coincide with the build-up of vector populations.

Wells for welfare or illfare? Cost of groundwater depletion in Coimbatore, Tamil Nadu, India

Water Policy ◽  
2008 ◽  
Vol 10 (4) ◽  
pp. 391-407 ◽  
Author(s):  
K. Palanisami ◽  
A. Vidhyavathi ◽  
C. R. Ranganathan
Keyword(s):  
Tamil Nadu ◽  
Economic Cost ◽  
Groundwater Depletion ◽  
Cropping Pattern ◽  
Watershed Development ◽  
Groundwater Overdraft ◽  
Well Spacing ◽  
Coimbatore District ◽  
Tamil Nadu State ◽  
The Cost

Groundwater depletion is experienced in several districts of Tamil Nadu state and Coimbatore district is heading in that direction. The average well failure rate is 47% for open wells and 9% for bore wells. The total cost of depletion for new wells varies from Rs 1,999 per ha to Rs 90,975 per ha. The electricity subsidy to the farmers has varied from Rs 22,621 per ha for coconut growers to Rs 25,498 per ha for banana growers as on 2004. The cost of irrigation per cubic metre (m3) is less on large farms. The average net return with free electricity varies from Rs 0.14 per m3 to Rs 1.38 per m3 and is drastically reduced when electricity is priced at an economic cost, i.e. Rs −1.15 to Rs −0.14 per m3. The shift in cropping pattern towards high value crops helped the farmers to some extent to bear the cost of externalities arising out of depletion. The social cost caused by groundwater overdraft is about Rs 554.3 million, which may increase when the well density increases further. Suggested policy options are to change the cropping pattern to less water-consuming crops, to invest in watershed development activities, to change inefficient pumpsets and to adopt well spacing norms.

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