Health Economics Studies

Funding Source: UNITAID through PSI Zimbabwe

Funding period: September 2015 – July 2019

Programme expenditures, supplemented by on-site observation and M&E data were used to estimate full economic total and unit costs per HIVST kit distributed by site during early implementation of the STAR HIVST distribution intervention in Malawi (n=11), Zambia (n=16) and Zimbabwe (n=44).  Inputs were categorised into start-up, capital and recurrent costs. Kit price was modelled using the current prices to account for observed price reductions. Sensitivity and scenario analyses assessed the impact of key parameters on unit costs.

Funding Source: Children’s Investment Fund Foundation (CIFF)

Funding Period: March 2017 – June 2019

Between January-May 2018 technical efficiency analysis was conducted in 20 purposefully selected health facilities providing PMTCT services in Zimbabwe. In each health facility, in-depth technical efficiency surveys were conducted through time and motion studies and clinical vignettes to assess service quality from the health care providers perspective. A facility costing tool was administered together with a patient exit tool that assessed service quality from the patients perspective as well as patient costs. The study also assessed variability in costs by site. A follow up survey will be conducted in 2019.

Funding Source: NIH K award (Sue Napierela)

Funding Period: January to September 2018

Data collection has begun (starting May 2018) on the Health economics in HIV prevention among young high risk women (YWSS) study. The overall goal of this research is to inform identification of the most cost-effective, efficient, and user-preferred package of services to increase engagement of YWSS in HIV services and reduce HIV transmission.  Aim 1 of this study is to estimate the costs and cost-effectiveness of the DREAMS intervention for YWSS in Zimbabwe. Aim 2 is to explore preferred attributes around intervention components and service delivery.

 

Using a combination of facility costing instruments, time and motion observation of clinic staff, and client exit interviews the study will determine client costs and time involved in attending clinic services. Costs of the DREAMS intervention, overall and per client served will be assessed and then combined with output data from the DREAMS IE to estimate the cost-effectiveness of DREAMS on HIV incidence and other secondary outcomes compared to the usual care sites. Incremental cost-effectiveness ratios (ICERs) will be calculated as [Difference in Net Cost] / [Difference in Health Outcome] by exposure to the overall intervention and its components.

Funding Source: ViiV Healthcare’s Positive Action for Adolescents Programme

Funding Period: February 2016 to March 2019

A within trial cost-effectiveness analysis of a community-based programme to improve adherence and retention in care among children and adolescents living with HIV in Zimbabwe will be conducted for the Enhanced Zvandiri Care (EZC) versus Standard of Care. This analysis will combine top down costing, where actual expenses data from project accounts (budgets and expenditure records) are collated and allocated in a step wise fashion to final cost centers and bottom up costing where each ingredient (input) or resource component is quantified and assigned a market related price. A quality of life (QALY) measure EQ-5D will be combined with a visual analogue scale (VAS) to estimate QALYs gained for the purposes of cost-effectiveness analysis.

Funding Source: USAID and PEPFAR through the OPTIONS Consortium

Funding Period: October 2015 to December 2020

A study is planned to cost initiation and retention of women on oral PrEP under different service delivery models in Zimbabwe. The aim of this costing project is to provide the MoHCC, implementers and development partners, including donors, with costing insights to inform introduction and scale up of oral PrEP. Specific objectives are to assess the annual total and unit cost of providing oral PrEP for AGYW and FSWs by service delivery model. The sites costed will represent four PSI/Z DREAMS sites, two PSI/Z Social Franchise Clinics, and one public health facility. Data collection and analysis is planned for July to December 2018.

Funding Source: Bill & Melinda Gates Foundation through PSI Zimbabwe

Funding Period: January 2017 to January 2019

Beginning June 2018 data collection will start under the VMMC catchup and sustainability phases involving cost, cost-effectiveness and technical efficiency analysis. Detailed costing and cost effectiveness analysis of community-based VMMC mobilization will be accompanied by technical efficiency analysis involving assessment of VMMC service quality from both the client and provider perspectives, patient costs and time and motion analysis.

Funding Source: UNITAID through PSI Zimbabwe

Funding Period: September 2015 – July 2019

Adopting the provider’s perspective and beginning September 2018 detailed costing will be conducted of all resources used in distribution of HIV self-testing services and supporting linkage in both distribution models. Both direct costs associated with intervention implementation, including resources required to attain and distribute HIVST kits; and indirect costs associated with supervision and administration will be included in the costing.

 

Costing will specifically account for inputs such as start-up (prior to implementation), stakeholder sensitisation and training, capital costs such as buildings, vehicles and equipment and recurrent costs such as human resources, supplies, building and vehicle operation and maintenance costs and waste management. Time and motion analysis will be employed to value both the direct financial and economic (in-kind) contribution of the community including opportunity cost of time expended on HIVST distribution activities by the community.

Community based distributors time will be valued based on their earnings/ allowances on the programme. If shown to be effective on the primary and secondary outcomes an incremental cost effectiveness analysis (ICER) will be conducted to compare the cost and outcomes of the alternative distribution approaches.