Estimating the cost-savings associated with bundling maternal and child health interventions: a proposed methodology.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Child Health Services/*economics ; Child Welfare/*economics ; Delivery of Health Care, Integrated/*economics ; Maternal Health Services/*economics ; Maternal Welfare/*economics; Child ; Child Health Services/organization & administration ; Cost Savings/economics ; Cost-Benefit Analysis ; Delivery of Health Care, Integrated/organization & administration ; Female ; Humans ; Kenya ; Maternal Health Services/organization & administration ; Namibia ; Pregnancy ; South Africa ; Uganda ; Zambia ; Zimbabwe

Background: There is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled.
Methods: First, a translog cost function is estimated to calculate factor shares of personnel, consumables, other direct (variable or recurrent costs excluding personnel and consumables) and indirect (capital or investment) costs. Primary source facility level data from Kenya, Namibia, South Africa, Uganda, Zambia and Zimbabwe are utilized, with separate analyses for hospitals and health centres. Second, the resulting other-direct and indirect factor shares are applied to country unit costs from the WHO CHOICE unit cost database to calculate those portions of unit cost. Third, the remainder of the costs is calculated using default data from the OHT. Fourth, we calculate the effect of bundling services by assuming that a LiST intervention visit takes an average of 20 minutes when delivered alone but only incremental time in addition to the basic visit when delivered in a bundle.
Results: Personnel costs account for the greatest share of costs for both hospitals and health centres at 50% and 38%, respectively. The percentages differ between hospitals and health centres for consumables (21% versus 17%), other direct (7.5% versus 6.75%), and indirect (22% versus 23%) costs. Combining the other-direct and indirect factor shares with the WHO CHOICE database and the other costs from OHT provides a comprehensive cost estimate of LiST interventions. Finally, the cost of six recommended antenatal care (ANC) interventions is $69.76 when delivered alone, but $61.18 when delivered as a bundle, a savings of $8.58 (12.2%).
Conclusions: This paper proposes a method for estimating a comprehensive cost of providing child and maternal health interventions by combining labor, consumables and drug costs from OHT with indirect and other-direct proportional costs from WHO CHOICE. In addition, we demonstrate the potential cost savings that can be achieved from bundling the delivery of essential antenatal care interventions rather than delivering the same interventions alone.

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Date Created: 20140226 Date Completed: 20150608 Latest Revision: 20240321

20240321

PMC3847650

10.1186/1471-2458-13-S3-S27

24564386