Bowser Diana, Sombrio Anna, Coulibaly Neto, Mark Noah
The Heller School for Social Policy and Management, Brandeis University.
J Glob Health Econ Policy. 2021 Oct 25;1(1). doi: 10.52872/001c.29068.
This study is a systematic literature review of HIV, nutrition, and primary care activity-based costing (ABC) studies conducted in low- and middle-income countries. ABC studies are critical for understanding the quantities and unit costs of the activities and resources for specific cost functions. The results of ABC studies enable governments, funders, and policymakers to utilize costing results to make efficient, cost-effective decisions on how to allocate scarce resources.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology for systematic literature reviews. Key search terms included: (1) activity-based costing and time-driven activity-based costing, (2) cost of services, (3) HIV interventions OR (4) primary health care. Terms were searched within article titles and abstracts in PubMed, EconLit, and Scopus.
1,884 abstracts were screened and reduced to 57 articles using exclusion criteria. After a full text review, 16 articles were included in the final data synthesis. Findings were used to classify costs into relevant and common inputs for activity-based costing. All costs were converted to unit cost (cost per patient) and inflated to January 2020 USD. The largest unit cost across nutrition services was training (US$194.16 per patient, 34.6% of total unit cost). The largest unit cost for HIV was antiretroviral therapy (ART) (US$125.41, 71.0%). The largest unit cost for primary care services was human resources (US$84.78, 62.5%). Overall costs per patient for HIV services were US$176.71, US$135.67 for primary care services, and US$561.68 for nutrition services. The costing results presented suggest that spending on HIV exceeds the actual cost of HIV services.
This is the first systematic literature review to summarize the costs of HIV, primary care, and nutrition services across activity-based costing studies. While there was a wide variation in the study designs and economic methods, many of the input cost categories were similar. With the increasing number of costing studies in countries around the world, understanding trends in costs by function and service can lead to greater efficiency in the implementation of HIV, primary care, and nutrition programs.
本研究是对在低收入和中等收入国家开展的关于艾滋病毒、营养及初级保健作业成本法（ABC）研究的系统文献综述。ABC研究对于理解特定成本功能的活动及资源的数量和单位成本至关重要。ABC研究结果能使政府、资助者和政策制定者利用成本核算结果，就如何分配稀缺资源做出高效、具成本效益的决策。
我们遵循系统评价和Meta分析的首选报告项目（PRISMA）方法进行系统文献综述。关键检索词包括：（1）作业成本法和时间驱动作业成本法，（2）服务成本，（3）艾滋病毒干预措施或（4）初级卫生保健。在PubMed、EconLit和Scopus数据库的文章标题和摘要中检索这些术语。
筛选了1884篇摘要，并根据排除标准将其减少至57篇文章。经过全文审查，16篇文章被纳入最终的数据综合分析。研究结果用于将成本分类为作业成本法的相关和常见投入。所有成本均转换为单位成本（每位患者的成本），并折算为2020年1月的美元价值。营养服务中最大的单位成本是培训（每位患者194.16美元，占单位总成本的34.6%）。艾滋病毒方面最大的单位成本是抗逆转录病毒疗法（ART）（125.41美元，占71.0%）。初级保健服务中最大的单位成本是人力资源（84.78美元，占62.5%）。艾滋病毒服务每位患者的总成本为176.71美元，初级保健服务为135.67美元，营养服务为561.68美元。所呈现的成本核算结果表明，艾滋病毒方面的支出超过了艾滋病毒服务的实际成本。
这是第一篇系统文献综述，总结了基于作业成本法研究的艾滋病毒、初级保健和营养服务成本。虽然研究设计和经济方法存在很大差异，但许多投入成本类别相似。随着全球各国成本核算研究数量的增加，按功能和服务了解成本趋势可提高艾滋病毒、初级保健和营养项目实施的效率。
