Service Delivery Costs Research Articles

The Costs and Cost-Effectiveness of a Two-Dose Oral Cholera Vaccination Campaign: A Case Study in a Refugee Camp Setting in Thailand

Oral cholera vaccination (OCV) campaigns are increasingly used to prevent cholera outbreaks; however, little is known about their cost-effectiveness in refugee camps. We conducted a cost-effectiveness analysis of a pre-emptive OCV campaign in the Maela refugee camp in Thailand, where outbreaks occurred with an annual incidence rate (IR) of up to 10.7 cases per 1000. Data were collected via health sector records and interviews and household interviews. In the base-case scenario comparing the OCV campaign with no campaign, we estimated the campaign effect on the cholera IR and case fatality rate (CFR: 0.09%) from a static cohort model and calculated incremental cost-effectiveness ratios for the outcomes of death, disability-adjusted life-years (DALYs), and cases averted. In sensitivity analyses, we varied the CFR and IR. The household economic cost of illness was USD 21, and the health sector economic cost of illness was USD 51 per case. The OCV campaign economic cost was USD 289,561, 42% attributable to vaccine costs and 58% to service delivery costs. In our base case, the incremental cost was USD 1.9 million per death averted, USD 1745 per case averted, and USD 69,892 per DALY averted. Sensitivity analyses that increased the CFR to 0.35% or the IR to 10.4 cases per 1000 resulted in a cost per DALY of USD 15,666. The low multi-year average CFR and incidence of the cholera outbreaks in the Maela camp were key factors associated with the high cost per DALY averted. However, the sensitivity analyses indicated higher cost-effectiveness in a setting with a higher CFR or cholera incidence, indicating when to consider campaign use to reduce the outbreak risk.

Core Mechanisms in Mediating eHealth Implementation and Uptake: A Case Study of Eastern Uganda

Researchers agree that, globally, in both developing and developed countries, healthcare management is faced with acute challenges: expanding areas of health needs, operationalizing health management, constrained budget allocations, as well as resource limitations. Hence, there is an imminent drive to find solutions to stimulate health system transformation through health system innovation. Therefore, effective national operational strategies to minimize resource wastage and contain the costs of health service delivery are critical. The study adopted a methodology that incorporated different research approaches and strategies. Deductive and inductive approaches were used; the strategies were surveys and case studies. A sample of 178 health professionals and administrators in three Health care facilities in Eastern Uganda, were determined and surveyed. Eligible respondents were stratified and selected through simple random sampling. Self-administered questionnaires and interview guides were used to gather the data. The captured data was analysed using Stata version 17. Regression analysis was used to determine the impact of eHealth Implementation core mechanisms on Quality Health Service Delivery. From the results of regression analysis, the core mechanisms variable had a p-value of 0.049 which was significant. For eHealth Implementation Core Mechanisms, the respondents have less control over them since they are dependent on several environmental factors, such as government funding or grants, Government regulations, and policies among others.

Spanish-speaking Patients' Experiences with Hearing Health Care.

Background/introduction: Health care providers working with Spanish-speaking patients must provide culturally and linguistically appropriate care to meet the communication needs of this population. Disparities related to hearing health care access remain understudied, leaving gaps in clinical practice and guidance for audiologists. The purpose of this study was to explore the experiences of Spanish-speaking patients with hearing loss when accessing hearing health care services through a limited income hearing aid program. Methods: Six Spanish-speaking patients (three monolingual Spanish, three bilingual Spanish/English) with hearing loss from the Oklahoma City metropolitan area completed in-depth, semi-structured interviews. Results/findings: Three main themes emerged: (1) perceived barriers to service delivery (cost, language, and transportation); (2) success with hearing health care (use of interpreters and reduced cost of services and amplification); and (3) cultural factors (family, religion, and use of home remedies). Discussion/conclusion: The themes identified can provide a foundation for service delivery of patient-centered services that are culturally and linguistically appropriate to help improve access to and quality of hearing health care, particularly for this population of patients. This study identified factors that may contribute to hearing health care disparities for Spanish-speaking adults, which may not be observed in other disciplines that are less communication-focused. Suggestions for improving services for audiologists serving Spanish-speaking patients are discussed.

Cross regional online food delivery: Service quality optimization and real-time order assignment

Online food delivery (OFD) represents a rapidly evolving e-business application that leverages cloud computing data centers, playing a crucial role in meeting the demands of urban lifestyles. With diverse order fulfillment features and increasing expectations for service quality, the task of effectively assigning riders for timely long-distance, cross-regional deliveries presents a significant engineering challenge. Previous studies often relied on traditional rider allocation methods that fail to account for varying capacities, or they utilized non-intelligent systems that did not adequately address fluctuating order demands and service delays. In this study, we introduce a robust Mixed Integer Linear Programming (MILP) optimization framework designed to minimize the total service time and delivery cost for cross-regional orders. This framework divides a large OFD area into multiple regions and utilizes both transfer vehicles and riders to optimize deliveries. To enhance the predictive accuracy of our model, we incorporate advanced machine learning techniques. Specifically, we employ the Long Short-Term Memory (LSTM) model to forecast regional order demands accurately, reflecting the dynamic nature of the marketplace. Additionally, Extreme Gradient Boosting (XGBoost) is tailored to dynamically predict travel times from restaurants to customer locations, facilitating more precise scheduling and resource allocation within the MILP framework. These machine learning techniques significantly bolster the MILP framework by providing detailed, accurate predictions that improve decision-making processes and adaptability to real-time conditions. Acknowledging the complexity of this optimization problem, we further enhance our approach by integrating a meta-heuristic algorithm, Adaptive Large Neighbor Search (ALNS), which efficiently assigns orders to the appropriate transfer vehicles and riders within polynomial time. Our Cross Regional Online Food Delivery (XROFD) system is meticulously designed to optimize both customer satisfaction and rider incentives. Simulation experiments confirm that the XROFD system not only reduces service times and delivery costs but also markedly enhances customer satisfaction and provides superior incentives for riders, outperforming existing state-of-the-art methods.

The Gap Between the Actual Cost and Tariffs of Global Surgical Procedures: A Retrospective Cross-sectional Study in Qazvin Province, Iran.

Iran's healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran's public hospitals. This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP's actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap. The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, P<0.001), females (B=26.7, 95% CI: 15.5-37.9, P<0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, P<0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, P<0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, P<0.001). Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.

Strategic analysis of Iran's climate resilient health system.

Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran's health system to climate change. This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system's resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran's health system's resilience to climate change was determined using the internal - external factors matrix. A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran's health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran's health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities' adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran's health system to climate change. Iran's health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran's health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

Telemedicine integration into the eye health ecosystem in scaling of effective refractive error coverage in Kenya

This study explored the potential of telemedicine integration into the eye health ecosystem with an aim of scaling effective refractive error coverage in Kenya. This exploratory study was conducted telephonically and through online interviews with key opinion leaders, ophthalmologists, optometrists, ophthalmic clinical officers, optical technicians and beneficiaries of the optical technician’s services in rural areas. A telemedicine workflow was developed and validated based on the comments from the key opinion leaders using the Delphi technique. Quantitative and qualitative data were analysed using SPSS and NVivo Software respectively. All of the key opinion leaders agreed that telemedicine is relevant in the eye health ecosystem and recognition of primary vision technicians is critical for effective telemedicine integration. The reasons for the need of telemedicine integration were categorized into; good relationship, organized refractive error service delivery, convenience and availability and cost reduction. The possible factors influencing integration of telemedicine identified were categorized into cost, unwillingness, dominance, perception, lack of technical team, policies and network coverage. The limited human resources in the eye health ecosystem in developing countries cannot effectively deliver refractive error services to the growing population. Hence, integration of telemedicine and establishment of policies recognizing telemedicine are desirable to strengthen task shifting and scale effective refractive error coverage.

Economic cost-benefit analysis of person-centred medicines reviews by general practice pharmacists

BackgroundMedicines reviews by general practice pharmacists improve patient outcomes, but little is known about the associated economic outcomes, particularly in patients at higher risk of medicines-related harm.AimTo conduct an economic cost-benefit analysis of pharmacists providing person-centred medicines reviews to patients with hyperpolypharmacy (prescribed ≥ 10 regular medicines) and/or at high risk of medicines-related harm across multiple general practice settings.MethodService delivery costs were calculated based on the pharmacist’s salary, recorded timings, and a general practitioner fee. Direct cost savings were calculated from the cost change of patients’ medicines post review, projected over 1 year. Indirect savings were calculated using two models, a population-based model for avoidance of hospital admissions due to adverse drug reactions and an intervention-based model applying a probability of adverse drug reaction avoidance. Sensitivity analyses were performed using varying workday scenarios.ResultsBased on 1471 patients (88.4% with hyperpolypharmacy), the cost of service delivery was €153 per review. Using the population-based model, net cost savings ranging from €198 to €288 per patient review and from €73,317 to €177,696 per annum per pharmacist were calculated. Using the intervention-based model, net cost savings of €651–€741 per review, with corresponding annual savings of €240,870–€457,197 per annum per pharmacist, were calculated. Savings ratios ranged from 181 to 584% across all models and inputs.ConclusionPerson-centred medicines reviews by general practice pharmacists for patients at high risk of medicines-related harm result in substantial cost savings. Wider investment in general practice pharmacists will be beneficial to minimise both patient harm and healthcare system expenditure.

Unpacking Sociotechnical Discourses on Telehealth Use and Data Protection: A Path Towards Digital Health Value Creation.

Telehealth uptake will remain sub-optimal without consumer trust. Safeguarding the security and privacy of health information plays an important role in building trust and acceptance of telehealth. This study seeks to unpack the sociotechnical discourses on the use of telehealth with a focus on privacy and security in the context of United States health services. A search of the media outlets facilitated via the Factiva database was conducted. Using a qualitative method, thematic analysis was performed on the news texts to identify the key themes and provide contextual explanations. The analysis led to the identification of three key themes: 'data protection practice', 'clinical resilience', and 'digital health business value' perspectives. These themes focus on various concepts of telehealth use including data privacy, security, public health emergency, compliance activities in the use of telehealth, meeting stakeholders' needs, reducing costs of service delivery, the potential of telehealth for informed action, and improving users' experience. Among these themes, 'data protection practice' was directly associated with privacy compliance and telehealth use. Other thematic discourses have provided an indirect reflection on the role of privacy compliance, with a greater emphasis placed on health service delivery and market dynamics rather than compliance in practice. Our study revealed the importance of the COVID-19 pandemic in telehealth use, highlighting the move towards 'good faith' and responsible use of telehealth.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

Cost volume profit analysis for full paying patient services in Malaysia: A study protocol.

Dual practice within public hospitals, characterised by the concurrent provision of public and private healthcare services within public hospitals, has become a widespread phenomenon. With the participation of selected public hospitals, dual practice within public hospitals, also known as Full Paying Patient services, was an initiative the Ministry of Health Malaysia took in 2007 to retain senior specialist physicians in Malaysia. The revenue generated from the Full Paying Patient services aims to provide an avenue for public sector specialists to supplement their incomes while alleviating the Government's burden of subsidising healthcare for financially capable individuals. However, the effectiveness of Full Paying Patient services in recouping service delivery costs and yielding a profit is still uncertain after 16 years of implementation. This study is designed to evaluate the impact of Full Paying Patient inpatient services volume, revenue, and cost on profit versus loss at selected hospitals from 2017 to 2020. From the perspective of healthcare providers, we plan to perform a cost volume profit analysis. This analysis enables us to determine the break-even point, at which total revenues match total costs, along with no-loss and no-profit thresholds for Full Paying Patient services. This study has the potential to provide insights into how variations in service volume, cost, and pricing impact healthcare providers' profitability. It also offers critical financial information regarding the volume of services required to reach the break-even point. A comprehensive understanding of service volume, cost and pricing is imperative for making informed decisions to fulfil the objectives and ensure the sustainability of the FPP services.

Financial Impact of Imaging Examination Site of Service in the Medicare Population.

The financial sustainability of the US healthcare system is a growing concern in an environment of declining reimbursement and rising costs. Variable Centers for Medicare and Medicaid (CMS) reimbursement and denial rates for specific imaging examinations exist across sites of service, adding complexity to financial planning for healthcare organizations. Understanding the financial implications of site of service in existing CMS reimbursement for imaging may be of strategic importance for organizations going forward. Current Procedural Terminology (CPT) codes were obtained for common cross-sectional imaging examinations using the 2022 CMS Medicare Physician Fee Schedule. Using reimbursement rates with historical volumes and denial rates, a simulation was created to estimate the overall reimbursement of paired hospital outpatient departments (HOPD) and free-standing office (FSO) sites. A baseline simulation was performed with random allocation of imaging examinations between sites of service, and an optimized simulation was performed to estimate the maximum financial impact of targeted allocation between sites. These simulations were performed for paired CT and MR scanners separately. For CT, the baseline simulation estimated annual average reimbursement for combined HOPD and FSO was $3.25M. Reimbursement increased to $3.51M after optimized reallocation of studies between sites of service, resulting in an expected gain of $260,162 for a set of paired HOPD and FSO scanners. For MR, the same approach resulted in baseline reimbursement of $2.51M, increasing to $2.60M upon reallocation between sites for an expected gain of $87,532. Assuming a stable cost of service delivery, this approach would result in improved margins of 8% for CT and 3.5% for MR. There were 28 CT and 19 MRI daily patient imaging appointments at each respective HOPD and FSO scanners, unchanged between baseline and optimized cases. Differences in reimbursement rates between sites were the dominant driver of increased margins at low denial rates, although denial rates became dominant at values greater than 50%. Given CMS payment and denial rate variability, optimally allocating imaging studies between sites of service may improve reimbursement for the same services delivered. Although financial incentives exist for site allocation, such decisions should require physician input to assess safety and appropriate level of care. This work contributes to an understanding of financial incentives of existing reimbursement policy and may guide future policy design towards high value care.

Real-Time Gamma Ray Log Generation from Drilling Parameters of Offset Wells Using Physics-Informed Machine Learning

Summary By 2026, USD 5.05 billion will be spent per year on logging while drilling (LWD) according to the market report from Fortune Business Insights (2020). Logging tools and wireline tools are costly services for operators to pay for, and the companies providing the services also have a high cost of service delivery. They are, however, an essential service for drilling wells efficiently. The ability to computationally generate logs in real time using known relationships between the rock formations and drilling parameters, namely, rate of penetration (ROP), rotations per minute (RPM), surface weight on bit (SWOB), surface torque (TQX), standpipe pressure (SPPA), and hookload (HKLD), provides an alternative method to generate formation evaluation information (analysis of the subsurface formation characteristics such as lithology, porosity, permeability, and saturation). This paper describes an approach to creating a digital formation evaluation log generator using a novel physics-informed machine learning (PIML) approach that combines physics-based approaches with machine learning (ML) algorithms. The designed approach consists of blocks that calculate mechanical specific energy (MSE), physical estimates of gamma ray (GR) using physical and empirical models, and formation information. All this information and the drilling parameters are used to build a classification model to predict the formations, followed by formation-based regression models to get the final estimate of GR log. The designed PIML approach learns the relationships between drilling parameters and the GR logs using the data from the offset wells. The decomposition of the model into multiple stages enables the model to learn the relationship between drilling parameters data and formation evaluation data. It makes it easier for the model to generate GR measurements consistent with the rock formations of the subject well being drilled. Because the computationally generated GR by the model is not just dependent on the relationships between drilling parameters and GR logs, this model is also generalizable and capable of being deployed into the application with only retraining on the offset wells and no change in the model structure or complexity. For this paper, the drilling of the horizontal section will not be discussed, as this was done as a separate body of work. Historically collected data from the US Land Permian Basin wells are used as the primary data set for this work. Results from the experiments based on the data collected from five different wells have been presented. Leave-one-out validation for each of the wells was performed. In the leave-one-out validation process, four of the wells represent the set of offset wells and the remaining one becomes the subject well. The same process is repeated for each of the wells as they are in turn defined as a subject well. Results show that the framework can infer and generate logs such as GR logs in real time. The average root-mean-squared error (RMSE) observed from the experiments is 27.25 api, representing about 10% error. This error value is calculated based on the mean estimate and does not consider the predicted confidence interval. Considering the confidence interval helps further reduce the error margin.

NEW INSIGHTS ON SURVIVABILITY IN MULTIPLE LINK AND NODE FAILURES OF OPTICAL NETWORKS

Survivability becomes increasingly critical in managing high-speed networks as data traffic continues to grow in both size and importance. In addition, the impact of failures is exacerbated by the higher data rates available in optical networks. The purpose of this study is to optimize the survivability approach to address the problem of capacity efficiency and fast recovery time of multiple link and node failures in one technique. Most research works done had only addressed either of these constraints in a single failure. This research intends to develop and implement a new integrated approach called Multi-Suv system model to address multiple failures in links and nodes of an optical network. Experiments was conducted to demonstrate the ability of the system model to identify the nature of failure based on the intensity of importance as defined in the fundamental scale of absolute numbers (Saaty, 1980); thus, inform on the path of restoration or protection to address the link and node failures. Following experimental simulations done on the model, the results shows that there are benefits amongst are reduced network resource usage, speedy recovery time, guaranteed availability and quality of reliability. The socio-economic value of this research will reduce the CAPEX capital investment of network infrastructures and facilities and OPEX the operational costs of service delivery of the ICT industry thereby increasing the profitability of the network and service providers. &#x0D; Keywords: WDM (Wavelength Division Multiplex), OXADM (Optical cross Add &amp; Drop Multiplexer), Intelli-MUX (Intelligent Multiplexer), DeMux (De-multiplexer, OPSS (Optical Switching System), OPXC (Optical Cross Connect), CAPEX (Capital expenditures), OPEX (Operations expenditures, OPM (Opinion Performance Matrix).

Costing the mental health harms of sexual and physical violence in adulthood: a prevalence-based analysis

Abstract Background When economists estimate how much violence ‘costs’, they rarely address the longer-term mental health harms resulting from sexual violence or the combined impact of sexual and physical violence, nor have most gender-disaggregated costs. Methods We applied prevalence-based modelling techniques to estimate the annual cost of experience of violence in adulthood, in terms of reduced quality of life and health service costs. Data were drawn from multiple sources, including the general population probability sample Adult Psychiatric Morbidity Survey. Prevalence and duration estimates used weighted data. Adjusted marginal effects for limiting mental health conditions and substance dependence were estimated for experience of sexual violence, physical violence, and sexual and physical violence combined. Disability weights were applied to estimate associated reduced quality of life and relative risks applied to health service delivery costs. Findings The estimated cost in 2019 of long-term reduced quality of life adults in England experienced because of violence during their adult years was £3,767 mil (€4,290 mil), with associated healthcare costs of £4,130 mil (€4703 mil). Both the costs of long-term lost quality of life and healthcare were higher in women than men. The costs associated with combined sexual and physical violence were particularly high, with an estimated 96% of these costs resulting from experiences of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim. Conclusions Sexual and physical violence both have substantial and independent associations with long-term mental distress, substance dependence and treatment and service use. Violence reduction interventions have the potential to reduce health service costs and increase population level quality of life. Future costings of sexual violence should fully incorporate the long-term impacts on mental health and gender-disaggregate estimate.

Costing of HIV services, Uganda and United Republic of Tanzania.

To evaluate resource allocation and costs associated with delivery of human immunodeficiency virus (HIV) services in Uganda and the United Republic of Tanzania. We used time-driven activity-based costing to determine the resources consumed and costs of providing five HIV services in Uganda and the United Republic of Tanzania: antiretroviral therapy (ART); HIV testing and counselling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. Country-based teams undertook time-driven activity-based costing with 1119 adults in Uganda and 886 adults in the United Republic of Tanzania. In Uganda, service delivery costs ranged from 8.18 United States dollars (US$) per visit for HIV testing and counselling to US$43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$3.67 per visit for HIV testing and counselling to US$28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. Establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden. Consistent engagement of implementation partners and standardized training and data collection instruments proved essential for the success of these exercises.

Costs of Coordinated Specialty Care for First-Episode Psychosis: A Microcosting Analysis.

In this study, the authors measured and described the costs of coordinated specialty care (CSC) for first-episode psychosis in Ohio. A microcosting tool was used to estimate personnel and nonpersonnel costs of service delivery at seven CSC programs. Average annual cost per participant (N=511 participants) was estimated as $17,810 (95% CI=$9,141-$26,479). On average, 61% (95% CI=53%-69%) of annual program costs were nonbillable. Key cost drivers included facility costs, administrative tasks, and social services. Novel financing models may redress reimbursement gaps incurred by CSC programs.

Health System Perspective on Cost for Delivering a Decision Aid for Prostate Cancer Using Time-driven Activity-based Costing.

Previsit decision aids (DAs) have promising outcomes in improving decisional quality, however, the cost to deploy a DA is not well defined, presenting a possible barrier to health system adoption. We aimed to define the cost from a health system perspective of delivery of a DA. Observational cohort. We interviewed or observed relevant personnel at 3 institutions with implemented DA distribution programs targeting men with prostate cancer. We then created process maps for DA delivery based on interview data. Cost determination was performed utilizing time-driven activity-based costing. Clinic visit length was measured on a subset of patients. Decisional quality measures were collected after the clinic visit. Total process time (minutes) for DA delivery was 10.14 (UCLA), 68 (Olive View-UCLA), and 25 (Vanderbilt). Total average costs (USD) per patient were $38.32 (UCLA), $59.96 (Olive View-UCLA), and $42.38 (Vanderbilt), respectively. Labor costs were the largest contributors to the cost of DA delivery. Variance analyses confirmed the cost efficiency of electronic health record (EHR) integration. We noted a shortening of clinic visit length when the DA was used, with high levels of decision quality. Time-driven activity-based costing is an effective approach to determining true inclusive costs of service delivery while also elucidating opportunities for cost containment. The absolute cost of delivering a DA to men with prostate cancer in various settings is much lower than the system costs of the treatments they consider. EHR integration streamlines DA delivery efficiency and results in substantial cost savings.

Rotavirus vaccine product switch in Ghana: An assessment of service delivery costs, switching costs, and cost-effectiveness.

Ghana introduced rotavirus vaccine (ROTARIX 1-dose presentation) into the routine national immunization program in 2012 and switched to a different product (ROTAVAC 5-dose presentation) in 2020. ROTAVAC has a lower price per dose (US$0.85 versus US$2.15 for ROTARIX) and smaller cold chain footprint but requires more doses per regimen (three versus two). This study estimates the supply chain and service delivery costs associated with each product, the costs involved in switching products, and compares the cost-effectiveness of both products over the next ten years. We estimated the supply chain and service delivery costs associated with ROTARIX and ROTAVAC (evaluating both the 5-dose and 10-dose presentations) using primary data collected from health facilities in six of the 14 regions in the country. We estimated the costs of switching from ROTARIX to ROTAVAC using information collected from key informant interviews and financial records provided by the government. All costs were reported in 2020 US$. We used the UNIVAC decision-support model to evaluate the cost-effectiveness (US$ per disability-adjusted life-year (DALY) averted from government and societal perspectives) of ROTARIX and ROTAVAC (5-dose or 10-dose presentations) compared to no vaccination, and to each other, over a ten-year period (2020 to 2029). We ran probabilistic sensitivity analyses and other threshold analyses. The supply chain and service delivery economic cost per dose was $2.40 for ROTARIX, $1.81 for ROTAVAC 5-dose, and $1.76 for ROTAVAC 10-dose. The financial and economic cost of switching from ROTARIX to ROTAVAC 5-dose was $453,070 and $883,626, respectively. Compared to no vaccination, the cost per DALY averted was $360 for ROTARIX, $298 for ROTAVAC 5-dose, and $273 for ROTAVAC 10-dose. ROTAVAC 10-dose was the most cost-effective option and would be cost-effective at willingness-to-pay thresholds exceeding 0.12 times the national GDP per capita ($2,206 in the year 2020). The switch from ROTARIX to ROTAVAC 5-dose in 2020 was cost-saving. Rotavirus vaccination is highly cost-effective in Ghana. A switch from ROTAVAC 5-dose to ROTAVAC 10-dose would be cost-saving and should be considered.

Unleashing the Economic Potential of Balochistan: The Dynamic Power of District Hub

Balochistan, one of Pakistan's largest and resource-rich provinces, faces significant challenges in realizing its economic potential. Despite abundant natural resources, Balochistan suffers from some of the country's worst poverty rates, with the second-highest multidimensional poverty rate after the formerly Federally Administered Tribal Areas. The sparse population across a vast land area poses a significant growth constraint due to low population density, challenging terrain, and high per-unit service delivery costs. The lack of urban clusters exacerbates the problem of regional disparity, with Quetta being the only large city in the province. Nevertheless, Hub district stands out as Balochistan's most productive district, with the agricultural, fisheries, and livestock industries contributing significantly to its economy. Moreover, the district is Balochistan's only industrial and financial center, producing, on average, 90% of the province's industrial output and generating 70% of its tax revenue. As one of the thriving districts of Balochistan, District Hub needs reorganization along with new lines that unleash its economic potential and become the economic growth engine of Balochistan. However, to fully realize Balochistan's potential, further measures must be taken to address the challenges of low population density, logistical difficulties, and regional disparity.