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Open Access 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.

Keywords: costing; methods; unit cost

Document Type: Research Article

Affiliations: 1: Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK 2: University of Cape Town, Cape Town, South Africa 3: Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK, Global Access, International Aids Vaccine Initiative, Amsterdam, The Netherlands 4: World Health Organization, Geneva, Switzerland 5: The George Institute for Global Health, New Delhi, India 6: University of the Philippines Manila, Manila, The Philippines 7: Curatio International Foundation, Tbilisi, Georgia 8: Armauer Hansen Research Institute, Addis Ababa, Ethiopia 9: Health Economics Research Unit, Kenya Medical Research Institute–Wellcome Trust Research Programme, Nairobi, Kenya 10: Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, UK, University of Oslo, Oslo, Norway

Publication date: November 1, 2022

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