Introduction
Materials and methods
Results
Category* | Distribution | Study** | Country | Perspective | Cost included | Guideline used*** | Year of price | Currency | Cost**** | Source | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Financial
|
Economic
| Per net delivered | Per treatment delivered | Per ITN delivered | Per treated net year | Per person protected | |||||||||
Public/Public | Campaign (Door-to-door) | C | Solomon Islands (Florida Islands) | Provider | Nets, insecticide, transport, fuel, repairs, wages, equipment, materials, facilities | Time taken | Yes | 1988/89 | SI$ | 3.85 (= US$ 1.97) | 341 | ||||
Campaign (Door-to-door) | C | China (Napo County) | Provider | Insecticide | No | 1990 – 92 | Yuan | 0.48F | 35 | ||||||
Campaign (Door-to-door) | CE | Northern Ghana (Kassena – Nankana district) | Provider | Nets, insecticide, wages, transport, supplies & services | Adjusted financial costs plus time of volunteers | Yes | 1993/94 | US$ (and Cedis) | 2.40 | 20 | |||||
General health facilities | CE | The Gambia | Provider | Nets, insecticide, etc. (taken from Picard et al. 1993) | Adjusted financial costs | No | 1990 | US$ | 6.24 | 36 | |||||
Campaign (Door-to-door) | C | Tanzania | Provider | Nets, insecticide, wages, transport | Cost of nets was annualised (but not discounted) | No | 1996 | US$ | 1.00F | 0.46F | 1.46F | 37 | |||
Campaign (Distrib. point not specified; assumed central) | CE | Thailand (Thai-Myanmar Border) | Patients | Direct medical costs, transportation, food | Time absent from work | Yes | 1994/95 | US$ | 38 | ||||||
Campaign (Door-to-door) | C | Pakistan (Afghan refugee camps) | Provider | Net, insecticide, operational costs | Cost of net annualised (but not discounted) | No | 1991 – 94 | US$ | 1.51 | 39 | |||||
Campaign (Fixed-site) | CE | South Africa (KwaZulu-Natal) | Provider | Nets, insecticide, wages, equipment, transport, storage space | Adjusted financial cost plus donated insecticide | Yes | 1999 | US$ (and Rand) | 3.82 | 40 | |||||
Campaign (Distrib. point not specified; assumed to be central) | CE | Thailand (Thai-Myanmar border) | Provider | Wages, material, capital cost | Yes | 1994 | US$ | 1.30F | 41 | ||||||
Antenatal Clinics | C | Kenya | Provider | Net and insecticide, transport | No | 2001 | US$ | 3.81F 5.26F, L | 19 | ||||||
Public/Public | Campaign (Door-to-door) | C | Columbia | Provider | Wages, per diems, insecticide, transport | Yes | 2001 | US$ | 5.10F (near) 12.40F (far) | 42 | |||||
Campaign (Fixed-site) | C | Tropical Africa | Provider | Nets, wages, allowances, transport | Yes | 2003 | US$ | 2.40F | 22 | ||||||
Campaign (Fixed-site) | CE | Kenya | Society | Insecticide, nets, wages, supplies, transport, buildings, equipment, furniture, water, time of users | Adjusted financial costs plus value of community labour | Yes | 1996 | US$ | 1.90NC 2.20N | 1.4NC 1.6N | 4 | ||||
Measles vaccination sites | C | Ghana | Provider | ITNs, training and supervision, transportation, community education | No | 2002 | US$ | 3.74F | 43 | ||||||
Public/Mixed | Campaign – fixed site (Field trial using PHC workers & villagers) | CE | The Gambia | Society | Insecticide, wages, transport, equipment, treatment, funeral expenses | Adjusted financial costs plus time of volunteers, carers, hours lost due to mourning | Yes | 1990 | US$ | 5.65 | 44 | ||||
Local clinics Mobile teams CHW | C | Afghanistan | Provider | Nets, insecticide, monitoring, supervision, training, clinic overheads, wages, transport | Cost per net was adjusted (but not of other capital items) | Yes | 1995 | US$ | 2.01 1.89 | 1.08 0.49 1.87 | 45 | ||||
Campaign (Door-to-door) | CE | The Gambia (National Programme) | Society (Provider + Community) | Insecticide, wages, supplies, services, transport, equipment, awareness campaign, community capital costs incl. nets | Adjusted financial costs plus community time and water | Yes | 1991 – 92 | US$ (and Dalasis) | 1.00N | 3.30N | 26 | ||||
Campaign (Fixed site) | C | Vietnam (Hoa Binh Province) | Provider | Insecticide, equipment, labour, nets and transport (purchased by community) | Adjusted financial costs | Yes | 1996 | US$ | 0.58 – 0.61P | 0.32P | 0.90 – 0.93 | 31 | |||
Mixed/Mixed | Public and private sales agents | C | Tanzania | Project costs and users' contributions | No | 1998 – 99 | US$ | 6.14 – 6.87F | 1.72 – 2.11F | 46 | |||||
Public and private sales agents | CE | Tanzania | Project implementation costs, user contributions, travel costs | Adjusted financial costs plus time of users, in-kind community contributions, donated inputs | Yes | 2000 | US$ (and Shillings) | 8.30F | 13.38 | 5 | |||||
General health facilities & commercial outlets | CE | Malawi | Provider | Capital and recurrent costs | Adjusted capital costs (assumed life-span as in Hanson et al. 2003) | Yes | 1998 – 2003 | US$ | 2.63 | 4.41 | 27 | ||||
Private/Mixed | Community (Community groups) | C, CE | Kenya (Western highlands) | Provider & Society | Wages, nets, insecticide, cost-recovery included and excluded in analysis | Adjusted financial costs plus opportunity cost of MoH Government, community, and of using NGO truck | Yes | 2000 | US$ (and Shillings) | 4.68 30.00O | 47,48 | ||||
Private/Private | Community | C | Benin (Savalou region) | Provider | Local mosquito net production, insecticide, transportation, wages | No | 1993 | US$ (and CFA) | 10.50F(sales price incl. profit) | 49 | |||||
Community (Community groups) | C | Kenya | Provider | Nets, netting material, insecticide, project running cost, monitoring, awareness campaign, training, transport | Some financial costs adjusted (but nets not included as capital items) | No | 2002 | US$ | 15.80F 14.40 | 9 | |||||
Formal sector retail outlet | C | The Gambia | Provider | Net (locally made), insecticide | Cost of net annualised but not discounted | No | 1987 | US$ | 1.75 | 0.30 | 2.05 | 50 |
Technical characteristics
Viewpoint taken
Types and clarity of cost measures
Sources of cost data
Issues of time
Choice of output and outcome measure
Sensitivity analysis
Discussion
Recommendations
Viewpoint
Costing
Resource identification
Resource measurement
Resource valuation
Data analysis
Reporting of results
Discussion of results
The recommendations are summarized in Table 2
Viewpoint | Use societal perspective. Sub-analyses can focus on specific perspectives such as provider, patient or Ministry of Health |
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Output | Clarify whether intervention delivers nets or treatment or both Calculate net and treatment costs separately |
Resource identification | Include all costs of behaviour change activities (including advertising) Include any costs of treating LLINs in campaigns Exclude research costs Include relevant overheads of collaborating organizations (e.g. NGO contributions to procurement, management, etc) Clarify what management capacity is assumed to exist and whether calculating average cost or incremental cost of adding intervention to an existing programme |
Resource measurement | Attempt to measure and report leakage of resources (e.g. nets used by individuals outside target groups) Establish average lifespan of net under local conditions |
Resource valuation | Treat nets as a capital item. Base case should assume life expectancy of 3 years and use discount rate of 3% Avoid double counting of user contributions where cost recovery applied, but ensure these are counted as user contributions when disaggregating costs by source |
Sensitivity analysis | Conduct sensitivity analysis on: discount rate (0%, 5%, 10% at a minimum); frequency of net impregnation, procurement cost of net and insecticide; number of people protected per net; lifespan of net Consider impact of research where this is conducted alongside a programme on programme effectiveness (see ref 5) Vary proportion of shared resources where distribution carried out as part of another programme/campaign |
Reporting of results | Provide costs in US$ and local currency Specify year in which costs calculated/adjusted Report cost per ITN delivered and cost per person sleeping under a net |
Discussion of results | Compare costs with per capita government health expenditure to aid assessment of affordability Be cautious in using cost estimates to scale up, and make explicit assumptions about whether marginal cost constant, increasing or decreasing |
The reference case
Parameter | Suggested Reference Scenario | Explanation |
---|---|---|
Perspective | Societal | To include all costs, not just those of the provider or patient. |
Currency | US$ | A cost estimate in US$, indicating the year of conversion should be provided in addition to local currency |
Life-span of mosquito net | 3 years | Assumptions have varied from 3 to 7 years, but field observations increasingly indicate a relatively short life span of polyester nets. Olyset® nets (made of polyethylene) are more durable and should be considered separately. |
Re-treatment | Annually | Treatment of mosquito nets with modern pyrethroids is generally assumed to last 6 – 12 months. Evidence for LLINs (Olyset® and PermaNet®) indicates that treatment lasts for the life span of the net [7, 8]. While LLINs are phased in, they may be retreated alongside conventional nets. It should be investigated if this is the case. |
Cost data | Include: All intervention costs (e.g. mosquito nets, insecticide, wages, transport, advertising, etc.) All time cost, including care giving (formal/informal) and volunteers Transportation and other non-medical services Administrative costs for sick leave and for other transfers Donated items | Costs for these and possible other ingredients (depending on programme specifics) should be collected. Costs can only be excluded once it has been established that they are insignificant in the context of the analysis [see reference 17 and 18 for further guidance). Quantities and prices need to be presented separately |
Revenue | Value and include | From the societal perspective, funds from cost-recovery need to be included. This needs careful attention to avoid double counting. Clearly indicate cost-recovery when presenting results. |
Adjustment of financial costs to calculated economic costs | ||
Annualisation | Life expectancy of capital items as specified above | To obtain an equivalent annual cost for each capital outlay, an annuitization procedure needs to be followed. This requires an estimate of the life expectancy of each capital item and a decision on the discount rate to be used (see below). |
Discount rate | 3% | Base-case calculations should use 3%, to be consistent with World Bank recommendations [32]. This should be varied in the sensitivity analysis, e.g. from 0 – 10%. |
Reporting of results | ||
Cost estimate | Cost per net ITN delivered | For programmes delivering untreated nets and insecticide treatment, the cost of both components should be quoted separately. Indicate whether the cost per ITN is the composite of the two costs or is achieved at lower/higher cost |