Abstract
BackgroundHuman resources are a major cost driver in childhood pneumonia case management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in Malawi can lead to savings on staff time and salaries due to reductions in pneumonia cases requiring admission. Reliable estimates of human resource costs are vital for use in economic evaluations of PCV-13 introduction.MethodsTwenty-eight severe and twenty-four very severe pneumonia inpatients under the age of five were tracked from admission to discharge by paediatric ward staff using self-administered timesheets at Mchinji District Hospital between June and August 2012. All activities performed and the time spent on each activity were recorded. A monetary value was assigned to the time by allocating a corresponding percentage of the health workers’ salary. All costs are reported in 2012 US$.ResultsA total of 1,017 entries, grouped according to 22 different activity labels, were recorded during the observation period. On average, 99 min (standard deviation, SD = 46) were spent on each admission: 93 (SD = 38) for severe and 106 (SD = 55) for very severe cases. Approximately 40 % of activities involved monitoring and stabilization, including administering non-drug therapies such as oxygen. A further 35 % of the time was spent on injecting antibiotics. Nurses provided 60 % of the total time spent on pneumonia admissions, clinicians 25 % and support staff 15 %. Human resource costs were approximately US$ 2 per bed-day and, on average, US$ 29.5 per severe pneumonia admission and US$ 37.7 per very severe admission.ConclusionsSelf-reporting was successfully used in this context to generate reliable estimates of human resource time and costs of childhood pneumonia treatment. Assuming vaccine efficacy of 41 % and 90 % coverage, PCV-13 introduction in Malawi can save over US$ 2 million per year in staff costs alone.
Highlights
Human resources are a major cost driver in childhood pneumonia case management
This can put a strain on the Expanded Programme on Immunization (EPI), the World Health Organization’s (WHO) initiative aimed at securing access to vaccination for all children in developing countries
Since co-payments on vaccines and injection supplies procured are required from all countries seeking GAVI Alliance support to introduce a new vaccine [4], information on the cost-effectiveness of any additions to the EPI in low-income settings such as Malawi are vital for both the national Government, in deciding on uptake, and GAVI, in deciding whether to offer support
Summary
Human resources are a major cost driver in childhood pneumonia case management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in Malawi can lead to savings on staff time and salaries due to reductions in pneumonia cases requiring admission. Since co-payments on vaccines and injection supplies procured are required from all countries seeking GAVI Alliance support to introduce a new vaccine [4], information on the cost-effectiveness of any additions to the EPI in low-income settings such as Malawi are vital for both the national Government, in deciding on uptake, and GAVI, in deciding whether to offer support. To inform these decisions, cost-effectiveness models compare the costs of introducing a vaccine with the cost of treating childhood pneumonia given the preand post-introduction incidence rates [5]
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