Brenzel Logan, Young Darwin, Walker Damian G
Bill & Melinda Gates Foundation, Seattle, Washington, United States.
UNC Gillings School of Global Public Health, Chapel Hill, NC, United States.
Vaccine. 2015 May 7;33 Suppl 1:A13-20. doi: 10.1016/j.vaccine.2014.12.066.
Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia.
This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented.
The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing.
This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial.
近年来，很少有基于机构的常规免疫（RI）项目详细成本核算研究，规划者、管理者和捐助者依赖于旧信息或规划工具中的数据。为了填补空白并提高信息质量，在贝宁、加纳、洪都拉斯、摩尔多瓦、乌干达和赞比亚开展了一项关于常规免疫和新疫苗成本核算与融资的多国研究（EPIC）。
本文阐述了开展EPIC研究的基本原理，并概述了常规项目和新疫苗引入在机构抽样、数据收集、成本和资金流估算通用方法中所使用的方法。成本核算从政府角度采用基于构成要素的方法。重点强调了在产能过剩情况下估算新疫苗引入的增量经济成本。介绍了使用更细分的卫生账户体系（SHA）编码来评估资金流。
EPIC研究选取了319个初级卫生保健机构作为样本，其中65%的机构位于农村地区。EPIC研究发现，每个国家内部以及不同国家之间的总成本和单位成本存在很大差异。成本随着国家规模水平和社会经济状况的提高而增加。政府在RI总融资中所占份额越来越大。
本研究提供了关于RI总成本、单位成本和融资的大量高质量信息，并展示了深入机构研究方法的价值。本文讨论了使用标准化方法所吸取的经验教训，并提出了方法学进一步发展的领域。本文讨论了研究结果如何用于资源筹集和分配、提高国家层面服务效率以及为全球层面政策提供参考。将成本分析常规化以支持可持续性努力的工作将是有益的。
