Department of Global Health, University of Washington, Seattle, WA, United States of America.
The Aurum Institute, Johannesburg, South Africa.
PLoS One. 2023 Nov 16;18(11):e0294449. doi: 10.1371/journal.pone.0294449. eCollection 2023.
Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings.
Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings.
VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively.
Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.
在南非，自愿男性包皮环切（VMMC）的客户需要多次接受术后随访。然而，由于 VMMC 已经被证明是安全的，在南非，诊所工作人员可能会每年对没有并发症的男性进行超过 40 万次不必要的复查。这项研究作为一项随机对照试验（RCT）的一部分，旨在测试双向、基于文本的（2wT）随访与成年客户常规门诊随访的安全性，其目的是比较农村和城市南非环境下 VMMC 后的 2wT 和常规护理的成本。
基于活动的成本核算（ABC）以美元估计了 VMMC 后的护理成本，包括咨询、随访和追踪。对于农村地区的 VMMC 和随访客户提供交通服务，但对于城市固定地点的客户不提供。数据来自国家卫生部 VMMC 表格、RCT 数据库和时间与动作调查。敏感性分析呈现了不同的随访方案。我们假设 2wT 总体上会降低每位客户的成本，在农村地区的节约效果更高。
从 1084 名 RCT 客户中估算了 VMMC 项目成本：常规护理 537 名，2wT 护理 547 名。平均而言，2wT 护理比常规护理节省每位客户 3.56 美元。按地点划分，2wT 为每位农村客户节省了 7.73 美元，为每位城市客户增加了 0.59 美元。如果男性分别参加一次或两次 VMMC 后的随访，2wT 将分别节省 2.16 美元和 7.02 美元的随访项目成本。
高质量的 2wT 随访护理通过支持大多数男性在家中康复，同时将有潜在并发症的患者分诊到及时的门诊护理，从而降低了整体 VMMC 后的护理成本。在农村地区，2wT 抵消了交通成本，因此节省更多。城市地区 2wT 的额外费用很少，反映了较高的护理质量和客户参与度，这是提高 VMMC 服务交付质量的一项值得投资。南非的 2wT 扩大规模可能会显著降低整体 VMMC 成本，同时保持服务质量。
