Unit Cost Estimates Research Articles

State of HIV costing in Latin America and the Caribbean: a systematic literature review.

To summarize available data on unit costs for human immunodeficiency virus (HIV) testing, prevention, and care interventions in Latin America and the Caribbean. We conducted a systematic literature review of costing studies published between 2012 and 2024, and selected those reporting empirically measured costing data. The available data were categorized according to predefined intervention categories and compared by time and place. We also explored variations in unit costs by intervention type. Of 1 746 studies identified, 22 met the inclusion criteria, which provided 103 unique unit cost estimates from nine countries. About 50% of the included studies were published between 2019 and 2021. Antiretroviral therapy services had the most cost data available (39% of unit costs), followed by inpatient care (27%) and HIV testing (24%). Considerable cost variations were observed both within and between interventions. Our analysis underscores the need for accurate and reliable cost data to support HIV budgeting and decision-making efforts. We identified several gaps in the availability of cost data and emphasize the importance of presenting results more effectively by incorporating key contextual variables. Given the challenges of shrinking budgets and sustainability risks, robust evidence is indispensable to inform priority setting and budget allocation for HIV services.

Cost and efficiency analysis in Iranian primary health centers: a micro costing and data envelopment analysis

BackgroundHealth Complex Model was implemented to provide primary health care services in urban, especially in slum areas. As a pilot at a provincial level, Chamran Health Complex offers healthcare for more than 57,000 residents of Tabriz. Despite the necessity of cost information in healthcare decision-making, there was limited knowledge about the unit cost of services. This study aims to analyze the cost and efficiency of health centers.MethodsActivity-Based Costing method with direct and step-down allocation methods was adopted. We estimated unit costs in a hypothetical scenario according to national standards to quantify the gap between current and standard practice. Input-oriented Data Envelopment Analysis was administered to measure the efficiency of health centers.ResultsThe total cost of the complex was $2,841,897, of which 67% ($1910373) and 33% ($931523) were accounted for direct and indirect costs, respectively. The vaccination center had the lowest ($9), and the occupational health center had the highest average unit cost ($76). The average technical efficiency of the health centers was 0.519, where the HC1 and HC3 showed the best performance.ConclusionThere is remarkable variability in service costs across health centers, which must be addressed in performance management and contracting practices. Although we found a gap between current and standard practice in terms of staff and facilities according to national standards, Chamran Health Complex has an untouched capacity that can be utilized with better planning and without incurring additional costs. It raises the need for revising national standards by the Iran Ministry of Health.

Energy, Exergy and Thermoeconomic Analyses on Hydrogen Production Systems Using High-Temperature Gas-Cooled and Water-Cooled Nuclear Reactors

The use of nuclear energy is inevitable to reduce the dependence on fossil fuels in the energy sector. High-temperature gas-cooled reactors (HTGRs) are considered as a system suitable for the purpose of reducing the use of fossil fuels. Furthermore, eco-friendly mass production of hydrogen is crucial because hydrogen is emerging as a next-generation energy carrier. The unit cost of hydrogen production by the levelized cost of energy (LCOE) method varies widely depending on the energy source and system configuration. In this study, energy, exergy, and thermoeconomic analyses were performed on the hydrogen production system using the HTGR and high-temperature water-cooled nuclear reactor (HTWR) to calculate reasonable unit cost of the hydrogen produced using a thermoeconomic method called modified production structure analysis (MOPSA). A flowsheet analysis was performed to confirm the energy conservation in each component. The electricity generated from the 600 MW HTGR system was used to produce 1.28 kmol/s of hydrogen by electrolysis to split hot water vapor. Meanwhile, 515 MW of heat from the 600 MW HTWR was used to produce 8.10 kmol/s of hydrogen through steam reforming, and 83.6 MW of electricity produced by the steam turbine was used for grid power. The estimated unit cost of hydrogen from HTGR is approximately USD 35.6/GJ with an initial investment cost of USD 2.6 billion. If the unit cost of natural gas is USD 10/GJ, and the carbon tax is USD 0.08/kg of carbon dioxide, the unit cost of hydrogen produced from HTWR is approximately USD 13.92/GJ with initial investment of USD 2.32 billion. The unit cost of the hydrogen produced in the scaled-down plant was also considered.

The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo

The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion...

Cost of image-guided percutaneous nephrostomy among cervical cancer patients at Muhimbili National Hospital in Tanzania

BackgroundMost cervical cancer patients in developing countries seek care in health facilities with an advanced disease, often characterized by obstructive uropathy. This study aims to estimate the cost of an image-guided percutaneous nephrostomy (PCN), which was recently introduced at Muhimbili National Hospital to manage obstructive uropathy.MethodsThis was a cross-sectional study that was conducted between February and June 2021, from the provider’s perspective. The study involved forty-eight (n = 48) cervical cancer patients with obstructive uropathy. A micro-costing approach was used to identify, quantify and value both capital and recurrent cost items consumed by the patients. Cost data were collected in Tanzanian shillings and converted to USD with the relevant exchange rate. Analysis was performed in Microsoft Excel (Microsoft Excel®, Microsoft Corporation).ResultsThe unit cost of image-guided PCN at Muhimbili National Hospital was estimated at 380.4 USD. The main cost drivers were the single-use Nephrostomy catheters, Amplatz guide wire, and Micro-puncture set. The estimated unit cost is higher than the reimbursement price of 237.4 USD charged by the National Health Insurance Fund, and the 259.4 USD and 172.9 USD charged by the hospital for private and public patients, respectively.ConclusionImage-guided PCN for cervical cancer patients costs three times the minimum monthly government wage. The study underscores the importance of conducting costing studies to inform pricing and reimbursement decisions in Tanzania.

D83. Watching Your Back: The Effect of Muscle Flap Coverage on Outcomes and Resource Utilization following Posterior Spinal Fusions

PURPOSE: Rates of spinal degenerative deformities and spondylosis have a prevalence of over 60% in elderly patients. An estimated $34 billion is spent annually on posterior spinal fusions (PSFs) and subsequent postoperative complications, which affect upwards of 20% of patients. Wound closure involving local muscle flaps has been associated with reduced rates of complications compared to primary closure. The rise in PSF rates and health expenditures underscores the need for healthcare utilization studies to inform decision-makers on best operative protocols. METHODS: A retrospective review was performed on adult patients who underwent PSF due to degenerative deformity or spondylosis. Health and economic outcomes were compared between PSF procedures with local muscle flap closure vs. primary closure. Patient-level costs were calculated using standard unit cost estimates derived from CMS Medicare fee schedules. RESULTS: 200 patients met our study criteria; 100 received prophylactic muscle flap closure by plastic surgery. The groups did not differ significantly in terms of gender, race, insurance status, surgical indication, or number of vertebrae fused. Patients who received muscle flaps had significantly fewer post-operative infections and readmissions, and more seromas. Use of muscle flaps did not increase operative time, length of stay, or outpatient resource utilization. Reductions in postoperative resource utilization without statistically significant increases in peri-operative costs resulted in an average cost reduction of $2,760 per patient. CONCLUSION: In this study, those who received muscle flap closure had fewer complications without the burden of increased resource utilization, providing useful information for stakeholders when deciding to implement this technique.

The Impact of Obesity in Saudi Arabia: Healthcare Resource Use and Costs Associated with Obesity-Related Complications.

Saudi Arabia has a high prevalence of obesity, which increases the risk of individuals experiencing multiple chronic complications. Only a few publications highlight the healthcare costs of obesity-related complications (ORCs) in Saudi Arabia. A micro-costing approach was used to estimate the healthcare costs associated with 10 ORCs. Experienced clinicians in public and private practice across different geographical regions in Saudi Arabia were asked to estimate healthcare resource use associated with each ORC, and estimated unit costs were obtained from hospital administrators. Estimated overall annual costs per patient were calculated as a weighted average of separate public and private sector costs. Individuals in Saudi Arabia with any single ORC incurred overall average annual healthcare costs of 2165-7558 US dollars (USD). Heart failure, chronic kidney disease, dyslipidemia, and type2 diabetes (T2D) were the most costly complications, mainly driven by monitoring and/or pharmacological treatment costs. In contrast, asthma, hypertension, and angina were the least costly complications. Costs in private healthcare were higher than in public healthcare; the largest differences (2359-2793USD) were noted for dyslipidemia, T2D, and osteoarthritis, mainly explained by differences in pharmacological treatment costs. These data suggest that ORCs result in a considerable financial burden to the healthcare system, and highlight the substantial cost savings that could be achieved by preventing or delaying the occurrence of ORCs in Saudi Arabia.

Unit Costs in Health Economic Evaluations: Quo Vadis, Austria?

Evidence-informed healthcare decision-making relies on high quality data inputs, including robust unit costs, which in many countries are not readily available. The objective of the Department of Health Economics' Unit Cost Online Database, developed based on systematic reviews of Austrian costing studies, is to make conducting economic evaluations from healthcare and societal perspectives more feasible with publicly available unit cost information in Austria. This article aims to describe trends in unit cost data sources and reporting using this comprehensive database as a case study to encourage relevant national and international methodological discussions. Database analysis and synthesis included publication/study characteristics and costing reporting details in line with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) with the year of the database launch as the cut-off point to assess how the methods have developed over time. Forty-two full economic evaluations and 278 unit costs were analyzed (2004-2016: 34 studies/232 unit costs, 2017-2022: 8 studies/46 unit costs). Although the reporting quality of costing details including the study perspective, unit cost sources and years has improved since 2017, the unit cost estimates and sources remained heterogeneous in Austria. While methodologically standardized national-level unit costs would be the gold standard, a systematically collated list of unit costs is a first step towards supporting health economic evaluations nationally.

Cost of TB services: approach and summary findings of a multi-country study (Value TB).

BACKGROUND: There are currently large gaps in unit cost data for TB, and substantial variation in the quality and methods of unit cost estimates. Uncertainties remain about sample size, range and comprehensiveness of cost data collection for different purposes. We present the methods and results of a project implemented in Kenya, Ethiopia, India, The Philippines and Georgia to estimate unit costs of TB services, focusing on findings most relevant to these remaining methodological challenges.METHODS: We estimated financial and economic unit costs, in close collaboration with national TB programmes. Gold standard methods included both top-down and bottom-up approaches to resource use measurement. Costs are presented in 2018 USD and local currency unit.RESULTS: Cost drivers of outputs varied by service and across countries, as did levels of capacity inefficiency. There was substantial variation in unit cost estimates for some interventions and high overhead costs were observed. Estimates were subject to sampling uncertainty, and some data gaps remain.CONCLUSION: This paper describes detailed methods for the largest TB costing effort to date, to inform prioritisation and planning for TB services. This study provides a strong baseline and some cost estimates may be extrapolated from this data; however, regular further studies of similar quality are needed to add estimates for remaining gaps, or to add new or changing services and interventions. Further research is needed on the best approach to extrapolation of cost data. Costing studies are best implemented as partnerships with policy makers to generate a community of mutual learning and capacity development.

Pyroprocessing unit cost estimation for a commercial facility using PRIDE actual costs in Korea

This study presents the process unit cost for a pyroprocessing commercial facility with an annual 400-ton production volume. The pyroprocessing unit cost was calculated as 1723 USD/kgHM. There are mainly-three elements in the cost of the pyroprocess: capital investment, operation and maintenance, and decommissioning and disposal. It is proven that the operation and maintenance cost is the key cost driver, taking up approximately 77% of pyroprocessing costs. This cost is the value estimated based on the actual cost of the PyRoprocess Integrated inactive DEmonstration (PRIDE) facility, which the Korea Atomic Energy Research Institute is currently operating. Accordingly, accuracy level and reliability are judged to be higher than the pyroprocessing unit cost estimated with the engineering estimation method based on the conceptual design published in the existing literature. In addition, the accurate pyroprocessing unit cost will determine the economic viability of the reprocessing option for sustainable nuclear power generation.

Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda

BackgroundGlobally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique.MethodsService and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars.ResultsIn Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff.ConclusionsThe findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households.Trial registration: ClinicalTrials.gov, identifier: NCT01972321.

Manufacturing Productivity with Worker Turnover

To maximize productivity, manufacturers must organize and equip their workforces to efficiently handle variable workloads. Their success depends on their ability to assign experienced and skilled workers to specialized tasks and coordinate work on production lines. Worker turnover may disrupt such efforts. We use staffing, productivity, and pay data from within a major consumer electronics manufacturer’s supply chain to study how firms should manage worker turnover and its effects using production decisions, wages, and inventory. We find that worker turnover impedes coordination between assembly line coworkers by weakening knowledge sharing and relationships. Publicly available unit-cost estimates imply that worker turnover accounts for $206–274 million in added direct expenses alone from defectively assembled units failing the firm’s stringent quality control. To evaluate managerial alternatives, we structurally estimate a dynamic equilibrium model (an Experience-Based Equilibrium) encompassing (1) workers’ endogenous turnover decisions and (2) the firm’s weekly planning of its production scheduling and staffing in response. In counterfactual analyses, a less turnover-prone, hence more productive, workforce significantly benefits the firm, reducing its variable production costs by 4.5%, or an estimated $928 million for the studied product. Such benefits justify paying higher efficiency wages even to less skilled workforces; furthermore, interestingly, rational inventory management policies incentivize self-interested firms to reduce rather than tolerate turnover. This paper was accepted by Vishal Gaur, operations management. Funding: The authors gratefully acknowledge support from the data sponsor, and K. Moon gratefully acknowledges support from the Wharton Dean’s Research Fund and the Claude Marion Endowed Faculty Scholar Award of the Wharton School. Supplemental Material: The online appendices are available at https://doi.org/10.1287/mnsc.2022.4476 .

Cost-effectiveness of remdesivir plus usual care versus usual care alone for hospitalized patients with COVID-19: an economic evaluation as part of the Canadian Treatments for COVID-19 (CATCO) randomized clinical trial.

Background:The role of remdesivir in the treatment of hospitalized patients with COVID-19 remains ill-defined. We conducted a cost-effectiveness analysis alongside the Canadian Treatments for COVID-19 (CATCO) open-label, randomized clinical trial evaluating remdesivir.Methods:Patients with COVID-19 in Canadian hospitals from Aug. 14, 2020, to Apr. 1, 2021, were randomly assigned to receive remdesivir plus usual care versus usual care alone. Taking a public health care payer’s perspective, we collected in-hospital outcomes and health care resource utilization alongside estimated unit costs in 2020 Canadian dollars over a time horizon from randomization to hospital discharge or death. Data from 1281 adults admitted to 52 hospitals in 6 Canadian provinces were analyzed.Results:The total mean cost per patient was $37 918 (standard deviation [SD] $42 413; 95% confidence interval [CI] $34 617 to $41 220) for patients randomly assigned to the remdesivir group and $38 026 (SD $46 021; 95% CI $34 480 to $41 573) for patients receiving usual care (incremental cost −$108 [95% CI −$4953 to $4737], p > 0.9). The difference in proportions of in-hospital deaths between remdesivir and usual care groups was −3.9% (18.7% v. 22.6%, 95% CI −8.3% to 1.0%, p = 0.09). The difference in proportions of incident invasive mechanical ventilation events between groups was −7.0% (8.0% v. 15.0%, 95% CI −10.6% to −3.4%, p = 0.006), whereas the difference in proportions of total mechanical ventilation events between groups was −5.7% (16.4% v. 22.1%, 95% CI −10.0% to −1.4%, p = 0.01). Remdesivir was the dominant intervention (but only marginally less costly, with mildly lower mortality) with an incalculable incremental cost effectiveness ratio; we report results of incremental costs and incremental effects separately. For willingness-to-pay thresholds of $0, $20 000, $50 000 and $100 000 per death averted, a strategy using remdesivir was cost-effective in 60%, 67%, 74% and 79% of simulations, respectively. The remdesivir costs were the fifth highest cost driver, offset by shorter lengths of stay and less mechanical ventilation.Interpretation:From a health care payer perspective, treating patients hospitalized with COVID-19 with remdesivir and usual care appears to be preferrable to treating with usual care alone, albeit with marginal incremental cost and small clinical effects. The added cost of remdesivir was offset by shorter lengths of stay in the intensive care unit and less need for ventilation. Study registration:ClinicalTrials. gov, no. NCT04330690

Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes.

BackgroundIn low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India’s largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals.MethodsThe costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district’s composite development score. We estimated unit costs for individual services—outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs.ResultsAt the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair.ConclusionsData on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00342-6.

Hospital Service Use Among Children With Obesity in Ireland: A Micro-costing Study

ABSTRACT Background Childhood obesity affects around 7–8% of children in Ireland and is associated with increased risks of health complications. Data on healthcare resource use and the related costs for children with obesity are important for research, future service-planning, efforts to reduce the burden on families, and care pathways. However, there is little or no data available to describe these in Ireland. Methods We undertook a retrospective chart review for 322 children attending a national paediatric weight management service to assess their hospital service utilisation, and the associated costs, over a four-year period. We used a micro-costing approach and estimated unit costs for different types of hospital services. Multivariable negative binomial regression analyses and Cragg hurdle models were used to assess characteristics associated with type, frequency and costs of hospital care. Results Eighty-two percent of children had severe obesity, and thirty-eight percent had a co-morbid condition. Over the four-year period, children had a mean of 27 (median 24, IQR 16–33) episodes of care at a mean cost of €2590 per child (median €1659, IQR 1026–3103). The presence of a co-morbid condition was associated with more frequent visits. Neither severity of obesity nor socioeconomic status were associated with overall service utilisation. The Cragg hurdle model did not identify statistically significant differences in hospital costs according to participant characteristics. Conclusion Children with obesity frequently visit a variety of paediatric services and children with co-morbid conditions have greater levels of hospital utilisation. Further research is needed with larger sample sizes to explore variation in healthcare utilisation in this population, and the relationship between common co-morbidities and weight status. This would facilitate assessment of the implications for care pathways and examination of associations between patient outcomes and related healthcare costs and cost-effectiveness.

Description of day case costs and tariffs of cataract surgery from a sample of nine European countries

BackgroundThe lack of transparency in the methodology of unit cost estimation and the usage of confidential or undisclosed information prevents cost comparisons and makes the transferability of the results across countries difficult. The objective of this article is to compare the methodologies used in the estimation of the cost of a day case cataract extirpation that are described in the official and publicly available sources and to study how these translate into different unit cost estimates.MethodsA literature review was conducted to identify the main sources of unit costs of cataract extirpation. A semi-structured questionnaire to obtain information on national costing methodologies was developed and sent to consortium partners in nine European countries. Additionally, publicly available sources of unit cost of cataract surgery in those countries included in the European Healthcare and Social Cost Database (EU HCSCD) were analysed.ResultsThe findings showed a considerable diversity across countries on unit costs varying from 432.5€ in Poland (minor degree of severity) to 3411.96€ in Portugal (major degree of severity). In addition, differences were found in the year of cost publication and on the level of detail of different types of cataract surgery. The unit of activity were Diagnosis-Related Groups in all countries except Slovenia. All unit costs include direct costs and variable overheads (except Germany where nursing costs are financed separately). Differences were identified in the type of fixed overheads included in unit costs. Methodological documents explaining the identification, measurement and evaluation of resources included in the unit costs, as well as use of appropriate cost drivers are publicly available only in England, Portugal and Sweden.ConclusionsWe can conclude that while unit costs of cataract extirpation are publicly available, the information on methodological aspects is scarce. This appears to pose a significant problem for cross-country comparisons of costs and transferability of results from one country to another.

Cervical Cancer: The outcomes of liquid-based cytology vs conventional cytology among HPV/DNA screening test positives of ever married 35 and 45 years old women in Kalutara district and unit cost estimation of colposcopy and biopsy

Background: One major drawback of the present National Cervical Cancer Screening programme is, the suboptimal sensitivity (53%) of the pap smear to detect Cervical Intraepithelial Neoplasia (CIN). HPV/DNA test is highly sensitive (92.9%) for CIN II viral load and the feasibility of HPV/DNA screening with conventional cytology for screen positive follow-up was successfully attempted. The sensitivity of Liquid Based Cytology (LBC) to detect CIN II+ is 79.1%. Objective: To describe the results of LBC vs conventional cytology among HPV/DNA screen positives of 35 and 45 year old ever-married women in MOH areas of Kalutara district. Methods: There are 15 Medical Officer of Health areas in Kalutara district and the Public Health Midwife area (n=413) is taken as a cluster. Three clusters were randomly selected in each MOH area (n=45) by the lot method. Eligible family registers were the sampling frame. Nine subjects in the 35 and 45 age cohort each from all 45 clusters were selected by consecutive sampling technique. The total number of 393 and 390 subjects from 35 and 45 age cohorts were subjected to cervical specimen collection at community Well Woman Clinics (WWC) after applying exclusion criteria at field and clinic setting. HPV/DNA screen positives were subjected to both LBC and pap smear. HPV/DNA screen positive with either conventional cytology or LBC≥ Atypical Squamous Cells of Undetermined Significance (ASCUS) were referred for colposcopy. The incremental cost of the pap smear was calculated. The Scenario-Building technique was used to calculate the per- procedure cost of colposcopy and biopsy. Results: The response rate of 35 and 45 age cohorts women was 97.5% and 96.5% respectively. The number of 25 (6.36%) among 35 and 18 (4.61%) among 45-year- old women were positive for HPV/DNA test. The number of 7 (1.78 %) among 35 year and 5 (1.28%) among 45 year old women had ≥ASCUS in conventional cytology, while the number of 10 (2.54%) among 35 years and 8 (2.05%) among 45 years old women had ≥ASCUS in LBC. Prevalence of CIN by colposcopy among 35 years and 45 years women for LBC vs conventional cytology were 1.53%, 1.28% and 1.53%, 1.03% respectively and there was no significant difference. No invalid results were reported for LBC and the treatment adherence for colposcopy was 86.7%. The incremental cost of pap smear was Rs. 626.18, while the per-procedure cost of colposcopy and biopsy was Rs.1528.15 and Rs.681.16. Conclusions and recommendations: To improve the quality and coverage of the programme HPV/DNA PCR test as a primary cervical cancer screening method with LBC for only screen positive follow-up can be recommended.

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

BackgroundAchieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels.MethodsThis study assesses Cambodia’s public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories.ResultsOverall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side ‘service space’ to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient.ConclusionsPublic health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.

Cost-effectiveness of school oral health prevention program: a case study of community dentistry, Mahidol University

School may be the only place where oral health services are provided for high-risk children with limited access to dental care. We found this to be a common situation in many low-income countries, compounded by a lack of dental personnel. A school oral health prevention program is widely implemented in Thailand; however, the program's cost-effectiveness is under-investigated. This research project evaluated the cost-effectiveness of a comprehensive school oral health program implemented in the academic setting from the provider’s perspective. The retrospective study was conducted using profile data of primary school children in low socioeconomic areas during the academic years 2009–2018 from the Mahidol school oral health program database. The program's effectiveness was measured as DMFT increment scores from the first to the sixth grade between the intervention and control groups. To estimate unit costs for preventive dental services, cost data were collected according to the WHO CostIt program. The total cost was determined based on two elements: recurrent cost and capital cost. The economic costs of the program in the 2015 academic year for first- to sixth-grade children were an average of 1,196,839.37 Baht (34,944.42 USD), comprised of recurrent costs (36.1%) and capital costs (63.9%). Personnel costs and equipment depreciation costs were a major part of recurrent costs and capital costs, respectively. Specifically, capital costs were accountable for more than half of total program costs. The incremental cost-effectiveness ratio (ICER) of the completed 5-year program compared with the control group was 4,035.31 Baht per DMFT avoided. The study findings, which suggested the effectiveness of this program, are useful for its extension and expansion. The cost-effectiveness of the oral prevention program indicated that it is worth implementing, especially for outreach and children of low socioeconomic status at high risk of caries.

Machine learning-based cost predictive model for better operating expenditure estimations of U.S. light rail transit projects

Inaccurate forecasts of operating expenditures (OPEX) during the planning phase for new Light Rail Transit (LRT) projects in the United States underestimated future costs by up to 45% ( Harmatuck, 2008 ). When OPEX exceeded projected levels, local transit agencies often reduced public transit services to operate within their respective annual budgets. Therefore, it is imperative for transit agencies to produce reasonably accurate planning estimates to secure sufficient funding to support future operations, maintenance, and service delivery associated with LRT systems. The research aimed to develop a more accurate LRT OPEX predictive model to be used during the planning stage. Traditional statistical analysis and various machine learning-based algorithms were utilized with input from 22 LRT systems in the United States spanning between 2008 and 2018 from various U.S. governmental public databases. This study extended the current state of practice that relied primarily on sum of unit-cost estimates (also known as the unit-cost method) which generally failed to produce accurate forecasts due to lack of engineering details at the planning stage. Existing research attempted to develop regression-based methodologies using system-based attributes but did not substantially increase prediction accuracy from using the unit-cost method. The research improved current practices and research by having developed a more accurate and replicable machine learning-based predictive model using available geographic, socio-economic and LRT system-related variables at the planning stage.