scholarly journals The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

2021 ◽  
Author(s):  
Cheryl Hendrickson ◽  
Lawrence Long ◽  
Craig van Rensburg ◽  
Cassidy Claassen ◽  
Mwansa Njelesani ◽  
...  
Keyword(s):  
Service Delivery ◽  
Hiv Infection ◽  
Annual Cost ◽  
Scale Up ◽  
User Support ◽  
Delivery Costs ◽  
Program Support ◽  
Prep Implementation ◽  
The Cost ◽  
Delivery Models

Introduction: Pre-exposure prophylaxis (PrEP) is effective at preventing HIV infection, but PrEP cost-effectiveness is sensitive to PrEP implementation and program costs. Preliminary studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and user support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Methods: Taking a guidelines-based approach for visits, labs and drugs assuming fidelity to the expanded 2018 Zambian PrEP guidelines, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within the HIV counselling and testing service at primary healthcare centres). Program start-up, provider, and user support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (in 2018 USD). Results: The annual cost per PrEP client varied greatly by program type, from $394 (AGYW) to $760 in an integrated program. Cost differences were driven largely by volume (i.e. the number of clients initiated/model/site) which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs, including staff and overheads, labs and monitoring, drugs and consumables ranged narrowly from $208-217/PrEP-user. Service delivery costs were a key component in the cost of PrEP, representing 36-65% of total costs. Reductions in service delivery costs per PrEP client are expected with further scale-up. Conclusions: The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and user support. Improved data on individual client resource usage (e.g. drugs, labs, visits) and outcomes (e.g. initiation, persistence) is required to get a better understanding of the true resource utilization, cost and expected outcomes and annual costs of different PrEP programs in Zambia.

scholarly journals Implementing TB preventive treatment within differentiated HIV service delivery models in global programs

2020 ◽  
Vol 10 (3) ◽  
pp. 104-110
Author(s):  
A. T. Boyd ◽  
B. Moore ◽  
M. Shah ◽  
C. Tran ◽  
H. Kirking ◽  
...  
Keyword(s):  
Service Delivery ◽  
Care Delivery ◽  
Scale Up ◽  
Preventive Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Emergency Plan ◽  
The Us ◽  
Living With Hiv ◽  
Delivery Models

Global HIV program stakeholders, including the US President’s Emergency Plan for AIDS Relief (PEPFAR), are undertaking efforts to ensure that eligible people living with HIV (PLHIV) receiving antiretroviral treatment (ART) receive a course of TB preventive treatment (TPT). In PEPFAR programming, this effort may require providing TPT not only to newly diagnosed PLHIV as part of HIV care initiation, but also to treatment-experienced PLHIV stable on ART who may not have been previously offered TPT. TPT scale-up is occurring at the same time as a trend to provide more person-centered HIV care through differentiated service delivery (DSD). In DSD, PLHIV stable on ART may receive less frequent clinical follow-up or receive care outside the traditional clinic-based model. The misalignment between traditional delivery of TPT and care delivery in innovative DSD may require adaptations to TPT delivery practices for PLHIV. Adaptations include components of planning and operationalization of TPT in DSD, such as determination of TPT eligibility and TPT initiation, and clinical management of PLHIV while on TPT. A key adaptation is alignment of timing and location for TPT and ART prescribing, monitoring, and dispensing. Conceptual examples of TPT delivery in DSD may help program managers operationalize TPT in HIV care.

scholarly journals Annual cost of antiretroviral therapy among three service delivery models in Uganda

2016 ◽  
Vol 19 ◽  
pp. 20840 ◽  
Author(s):  
Lung Vu ◽  
Samuel Waliggo ◽  
Brady Zieman ◽  
Nrupa Jani ◽  
Lydia Buzaalirwa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Service Delivery ◽  
Annual Cost ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Estimating the cost of implementing a facility and community score card for maternal and newborn care service delivery in a rural district in Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anthony Ssebagereka ◽  
Rebecca Racheal Apolot ◽  
Evelyne Baelvina Nyachwo ◽  
Elizabeth Ekirapa-Kiracho
Keyword(s):  
Service Delivery ◽  
Average Cost ◽  
Scale Up ◽  
Newborn Care ◽  
Technical Support ◽  
Rural District ◽  
Total Annual Cost ◽  
District Health ◽  
Score Card ◽  
The Cost

Abstract Introduction This paper aimed at estimating the resources required to implement a community Score Card by a typical rural district health team in Uganda, as a mechanism for fostering accountability, utilization and quality of maternal and child healthcare service. Methods This costing analysis was done from the payer’s perspective using the ingredients approach over five quarterly rounds of scoring between 2017 and 2018. Expenditure data was obtained from project records, entered and analyzed in Microsoft excel. Two scale-up scenarios, scenario one (considered cost inputs by the MakSPH research teams) and scenario two (considering cost inputs based on contextual knowledge from district implementing teams), were simulated to better understand the cost implications of integrating the Community Score Card (CSC) into a district health system. Results The total and average cost of implementing CSC for five quarterly rounds over a period of 18 months were USD 59,962 and USD 11,992 per round of scoring, respectively. Considering the six sub-counties (including one Town Council) in Kibuku district that were included in this analysis, the average cost of implementating the CSC in each sub-county was USD 1998 per scoring round. Scaling-up of the intervention across the entire district (included 22 sub-counties) under the first scenario would cost a total of USD 19,003 per scoring round. Under the second scaleup scenario, the cost would be lower at USD 7116. The total annual cost of scaling CSC in the entire district would be USD 76,012 under scenario one compared to USD 28,465 under scenario two. The main cost drivers identified were transportation costs, coordination and supervision costs, and technical support to supplement local implementers. Conclusion Our analysis suggests that it is financially feasible to implement and scale-up the CSC initiative, as an accountability tool for enhancing service delivery. However, the CSC design and approach needs to be embedded within local systems and implemented in collaboration with existing stakeholders so as to optimise costs. A comprehensive economic analysis of the costs associated with transportation, involvement of the district teams in coordination, supervision as well as provision of technical support is necessary to determine the cost-effectiveness of the CSC approach.

scholarly journals Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe

2021 ◽  
Author(s):  
Mariet Benade ◽  
Brooke E Nichols ◽  
Geoffrey Fatti ◽  
Salome Kuchukhidze ◽  
Kudakwashe Takarinda ◽  
...  
Keyword(s):  
Viral Load ◽  
Service Delivery ◽  
Annual Cost ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Differentiated Service ◽  
Community Based ◽  
Cluster Randomized ◽  
Delivery Models

Background: About 85% of Zimbabwe's >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication dispensing and community-based service delivery. We evaluated the costs to providers and patients of community-based, multi-month ART delivery models in Zimbabwe. Methods:We used resource and outcome data from a cluster-randomized non-inferiority trial of three differentiated service delivery (DSD) models targeted to patients stable on ART: 3-month facility-based care (3MF), community ART refill groups (CAGs) with 3-month dispensing (3MC), and CAGs with 6-month dispensing (6MC). Using local unit costs, we estimated the annual cost in 2020 USD of providing HIV treatment per patient from the provider and patient perspectives. Results:In the trial, retention at 12 months was 93.0% in the 3MF, 94.8% in the 3MC, and 95.5% in the 6MC arms. The total average annual cost of HIV treatment per patient was $187 (standard deviation $39), $178 ($30), and $167 ($39) in each of the three arms, respectively. The annual cost/patient was dominated by ART medications (79% in 3MF, 87% in 3MC; 92% in 6MC), followed by facility visits (12%, 5%, 5%, respectively) and viral load (8%, 8%, 2%, respectively). When costs were stratified by district, DSD models cost slightly less, with 6MC the least expensive in all districts. Savings were driven by differences in the number of facility visits made/year, as expected, and low uptake of annual viral load tests in the 6-month arm. The total annual cost to patients to obtain HIV care was $10.03 ($2) in the 3MF arm, $5.12 ($0.41) in the 3MC arm, and $4.40 ($0.39) in the 6MF arm. Conclusions:For stable ART patients in Zimbabwe, 3- and 6-month community-based multi-month dispensing models cost less for both providers and patients than 3-month facility-based care and had non-inferior outcomes.

scholarly journals Economic Analysis of an Ambulatory Care Service Delivery Model for Hemophilia a Patients; A Cost Minimization Study

2020 ◽  
pp. 1-6
Author(s):  
Abolfazl Sadeghi ◽  
Majid Davari ◽  
Zahra Gharibnaseri ◽  
Roya Ravanbod ◽  
Peyman Eshghi
Keyword(s):  
Sensitivity Analysis ◽  
Service Delivery ◽  
Annual Cost ◽  
Hemophilia A ◽  
Cost Minimization ◽  
Treatment Model ◽  
Service Delivery Model ◽  
Delivery Model ◽  
Episodic Treatment ◽  
The Cost

Aim: This study aimed to perform an economic evaluation of Hemophilia ambulatory service delivery model (HASDM) comparing to the traditional home-episodic treatment model. Study Design: Tehran university of medical science, department pharmacoeconomics and pharmaceutical administration, between Jun 2016 and September 2018. Methods: A cost-minimization analysis (CMA) was conducted for evaluating potential savings of HASDM in comparison to the traditional home-episodic treatment model. The main cost of regular episodic service delivery, basic arm, consists of the cost of recombinant factor VIII (FVIII). In the comparator arm, HASDM, the costs of HASDM for 1660 hemophilia A patients (HAPs) in Tehran were calculated. One-way sensitivity analysis was done to investigate the robustness of the results and to investigate the impact of uncertainty in the percentage of mistakes in bleeding sensation. Results: There were 1660 patients with severe Hemophilia A (PWSHA) in Tehran in 2018. The mean utilization of annual per patient FVIII was 44814 international units (IUs) in Iran. The total annual cost of FVIII concentrate for 1660 hemophilic patients in Tehran was estimated at $ 11,001,816. The cost of running HASDM, personal, and equipment is equal to $ 580,956. The cost of FVIII in HASDM would be $ 4,004,661. Therefore, the total cost of HASDM is estimated at $ 4,585,617. The amount of savings was $ 6,416,199. Sensitivity analysis indicated the robustness of the results up to 94.64% of the variation in the model parameters. Conclusions: HASDM, compared to episodic model, can save 58.32% of the funding for controlling bleeding in HAPs annually. This can save more than 38 times of HAPs annual cost over their lifetime.

Reimbursement and Telepractice

2013 ◽  
Vol 3 (2) ◽  
pp. 35-40
Author(s):  
Carol Dudding
Keyword(s):  
Service Delivery ◽  
Healthcare Services ◽  
Speech Language Pathology ◽  
Delivery Method ◽  
Quality Healthcare ◽  
Service Delivery Models ◽  
Private Lives ◽  
Language Pathology ◽  
Delivery Models

Whether in our professional or private lives, we are all aware of the system wide efforts to provide quality healthcare services while containing the costs. Telemedicine as a method of service delivery has expanded as a result of changes in reimbursement and service delivery models. The growth and sustainability of telehealth within speech-language pathology and audiology, like any other service, depends on the ability to be reimbursed for services provided. Currently, reimbursement for services delivered via telehealth is variable and depends on numerous factors. An understanding of these factors and a willingness to advocate for increased reimbursement can bolster the success of practitioners interested in the telehealth as a service delivery method.

scholarly journals Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

2019 ◽  
Vol 97 (1) ◽  
pp. 113-175 ◽  
Author(s):  
CATHERINE J. EVANS ◽  
LUCY ISON ◽  
CLARE ELLIS‐SMITH ◽  
CAROLINE NICHOLSON ◽  
ALESSIA COSTA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Service Delivery ◽  
Older People ◽  
End Of Life ◽  
Rapid Review ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

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