Ahanhanzo Césaire Damien, Huang Xiao Xian, Le Gargasson Jean-Bernard, Sossou Justin, Nyonator Frank, Colombini Anais, Gessner Bradford D
Agence de Médecine Préventive (AMP), Ferney-Voltaire, France.
Agence de Médecine Préventive (AMP), Ferney-Voltaire, France.
Vaccine. 2015 May 7;33 Suppl 1:A66-71. doi: 10.1016/j.vaccine.2014.12.069.
Existing tools to evaluate costs do not always capture the heterogeneity of costs at the facility level. This study seeks to address this issue through an analysis of determinants of health facility immunization costs.
A statistical analysis on facility routine delivery and vaccine costs was conducted using ordinary least squares regression. Explanatory variables included the number of doses administered; proportion of time spent by facility staff on immunization; average staff wage; whether the health facility had enough staff; presence of cold chain equipment; distance to a vaccine collection point; and, facility ownership. Data were drawn from representative samples of primary care facilities in Benin and Ghana (46 and 50 facilities, respectively) collected as part of the EPIC studies.
Weighted average RI immunization facility cost was US$ 16,459 in Ghana and US$ 14,994 in Benin. The regression found total doses administered to be positively and significantly associated with facility cost in both countries. A 10% increase in doses resulted in a 4% increase in cost in Ghana, and a 7.5% increase in Benin. In Ghana, the proportion of immunization time, presence of cold chain, and sufficiency of staff were positively and significantly associated with total cost. In Benin, facility cost was negatively and significantly related to distance to the vaccine collection point. In the pooled sample, facilities in capital cities were associated with significantly higher costs.
This study provides evidence on the importance of the level of scale in determining facility immunization cost, as well as the role of availability of health workers and time they spend on immunization in Ghana and Benin. This type of analysis can provide insights into the costs of scaling up immunization services, and can assist with development of more efficient immunization strategies.
现有的成本评估工具并不总能反映医疗机构层面成本的异质性。本研究旨在通过分析医疗机构免疫成本的决定因素来解决这一问题。
采用普通最小二乘法回归对医疗机构常规分娩和疫苗成本进行统计分析。解释变量包括接种剂量数；医疗机构工作人员用于免疫接种的时间比例；平均员工工资；医疗机构是否有足够的工作人员；冷链设备的配备情况；到疫苗收集点的距离；以及医疗机构的所有权。数据来自作为EPIC研究一部分收集的贝宁和加纳初级保健机构的代表性样本（分别为46个和50个机构）。
加纳加权平均RI免疫接种机构成本为16,459美元，贝宁为14,994美元。回归发现，在两国，接种的总剂量均与机构成本呈正相关且具有统计学意义。接种剂量增加10%，加纳的成本增加4%，贝宁增加7.5%。在加纳，免疫接种时间比例、冷链设备的配备情况以及工作人员的充足程度与总成本呈正相关且具有统计学意义。在贝宁，机构成本与到疫苗收集点的距离呈负相关且具有统计学意义。在汇总样本中，首都城市的机构成本显著更高。
本研究提供了证据，证明规模水平在决定机构免疫成本方面的重要性，以及加纳和贝宁卫生工作者的可获得性及其用于免疫接种的时间所起的作用。这类分析可以深入了解扩大免疫服务的成本，并有助于制定更有效的免疫策略。
