Zegeye Elias Asfaw, Mbonigaba Josue, Kaye Sylvia, Johns Benjamin
Economics Department, University of KwaZulu-Natal, Durban, South Africa.
Abenezer Consulting PLC, Economic Evaluation and Health Care Financing Division, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2019 Mar 6;19(1):148. doi: 10.1186/s12913-019-3978-4.
While local context costing evidence is relevant for healthcare planning, budgeting and cost-effectiveness analysis, it continues to be scarce in Ethiopia. This study assesses the cost of providing a prevention of mother-to-child transmission of HIV/AIDS (PMTCT) service across heterogeneous prevalence (high, low) and socio-economic (urban, rural) contexts.
A total of 12 health facilities from six regions in Ethiopia were purposively selected from the latest 2012 antenatal sentinel HIV prevalence report. Six health facilities with the highest HIV prevalence (8.1 to 17.3%) in urban settings and six health facilities with the lowest prevalence (0.0 to 0.1%) in rural settings were selected. A micro-costing approach was applied to identify, measure and value resources used for the provision of a comprehensive PMTCT service. The analysis was conducted across different PMTCT service packages. We also estimated national costs in urban and rural contexts.
The average cost per pregnant woman-infant pair per year (PPY) ranged from ETB 6280 (USD 319) to ETB 21,620 (USD 1099) in the urban high HIV prevalence health facilities setting. In rural low HIV prevalence health facilities, the cost ranged from ETB 4323 (USD 220) to ETB 7539 (USD 383).PMTCT service provision in urban health facilities costs more than twice the cost in rural health facilities. The average cost per PPY in an urban setting was more than double the cost in a rural setting due to the higher cost of inputs and possible inefficiencies (although there were a higher number of visits). Consumables (including antiretroviral drugs) and infrastructure were the major cost drivers in both the urban and rural health facilities. Among PMTCT service components, anti-retroviral treatment Option B+ follow-up and counselling accounted for the highest proportion of costs, which ranged from 58 to 72%. Nationally, at the current coverage, the cost of PMTCT service was USD 6 million and USD 3 million in urban and rural settings, respectively.
The analysis suggests that resources used for PMTCT service packages varied across health facilities and HIV prevalence contexts. Providing PMTCT service in the high HIV prevalence urban health facilities costs more than in the rural facilities. Context-specific costing was vital to provide locally sensitive evidence for health service management and priority setting.
虽然当地背景成本核算证据对医疗保健规划、预算编制和成本效益分析很重要，但在埃塞俄比亚仍然稀缺。本研究评估了在不同患病率（高、低）和社会经济背景（城市、农村）下提供预防母婴传播艾滋病毒/艾滋病（PMTCT）服务的成本。
从埃塞俄比亚六个地区的最新2012年产前哨点艾滋病毒流行率报告中，有目的地选取了12个卫生设施。选取了城市环境中艾滋病毒患病率最高（8.1%至17.3%）的六个卫生设施和农村环境中患病率最低（0.0%至0.1%）的六个卫生设施。采用微观成本核算方法来识别、衡量和评估用于提供全面PMTCT服务的资源。分析针对不同的PMTCT服务包进行。我们还估计了城市和农村背景下的全国成本。
在城市艾滋病毒高流行率的卫生设施环境中，每对孕妇-婴儿每年（PPY）的平均成本从6280埃塞俄比亚比尔（319美元）到21620埃塞俄比亚比尔（1099美元）不等。在农村艾滋病毒低流行率的卫生设施中，成本从4323埃塞俄比亚比尔（220美元）到7539埃塞俄比亚比尔（383美元）不等。城市卫生设施中提供PMTCT服务的成本是农村卫生设施的两倍多。城市环境中每PPY的平均成本是农村环境的两倍多，这是由于投入成本较高以及可能存在的效率低下（尽管就诊次数较多）。消耗品（包括抗逆转录病毒药物）和基础设施是城市和农村卫生设施中的主要成本驱动因素。在PMTCT服务组成部分中，抗逆转录病毒治疗方案B+的随访和咨询占成本的比例最高，范围从58%到72%。在全国范围内，按照目前的覆盖率，城市和农村环境中PMTCT服务的成本分别为600万美元和300万美元。
分析表明，用于PMTCT服务包的资源在不同卫生设施和艾滋病毒流行情况背景下有所不同。在艾滋病毒高流行率的城市卫生设施中提供PMTCT服务的成本高于农村设施。特定背景的成本核算对于为卫生服务管理和确定优先事项提供当地敏感证据至关重要。
