NASA Expenditure Estimation- Costing HIV services and programs

Transcription

1 NASA Expenditure Estimation- Costing HIV services and programs Presenter: Christian Arán Date: December 4 th 2007 Place: Bucharest, Romania 1 1

2 "Imagination governs the world." Napoleon Bonaparte 2 2

3 NASA Resource Tracking: Not Resource Needs neither economic impact. Actual Expenditure: Goods & Services delivered 3 3

4 Actual Expenditure Budgets usually have important differences with Budget execution Budget execution does not reflects total HIV expenditure: some expenditures are not HIV Budgeted (i.e.: Human resources in OI, STI, ARV, etc, and some drugs are not reflected in HIV budgets since they are not HIV specific). 4 4

5 Resource Tracking RESOURCE TRACKING: DETERMINE WHAT IS ACTUALLY DISBURSED OR SPENT EIGHT HIV/AIDS PROGRAMMATIC AREAS ACTUAL EXPENDITURE! 5 5

6 Resource Tracking FINANCING SOURCE RESOURCE TRACKING: Resources are transferred from the financing sources, to a Financial Agent(s) and finally to a Provider(s) for the production of Good and Services. $ FINANCING AGENT $ PROVIDER Good, Services (Activities) 6 6

7 Resource Tracking RESOURCE TRACKING: If there is no TRANSACTION = There is no Resource Tracking EXAMPLES: VOLUNTEER WORKING CAPITAL DEPRECIATION BUDGETS NO RESOURCE TRACKING = NO EXPENDITURE TO ESTIMATE = OUTSIDE NASA BOUNDARIES 7 7

8 Resource Tracking RESOURCE TRACKING / ACTUAL EXPENDITURE USUALLY ACTUAL EXPENDITURE IS NOT CAPTURED IN SECONDARY DATA COSTING PRODUCTION OF GOOD & SERVICES IT IS NECESSARY TO PRODUCE ESTIMATES: EXPENDITURE ESTIMATES (PRIMARY DATA) 8 8

9 Estimating Expenditures - P x Q Approach Capturing Expenditure Services & Goods delivered. P x Q important tool for capturing expenditure. P x Q = Prices by Quantity = Good & Services Consumed. Q = Quantity consumed ; P = Price paid P in Public sector sometimes is Cost. 9 9

10 Estimating Expenditures Many Methods Approaches to estimate expenditure. The method to choose depends on the level of accuracy we want to reach. Trade off between accuracy and resources: Accuracy Resources consumed (time, money) 10 10

11 Treatment Data on Treatment expenditures: Usually not available We need to estimate the expenditure, sometimes using costing tools (costing expenditure) 11 11

12 Treatment Sources of information-data: Existing data: Official certified data, investigations (rare) Expenditure Estimations: Clinical records, Average treatment by Experts consultation, other

13 Example of Estimating Expenditure: Treatment Usually not under AIDS budget lines: STI treatment. OI treatment. ARV treatment salaries

14 Treatment Salaries Drugs, Materials Discharges Out Patients Outputs Beneficiary Population Equipment, Capital Energy Inputs How to track service costs of a particular disease?: - Data Bases -Private Sectors: Receipts - Medical Records - Surveys 14 14

15 Treatment What is a treatment: A basket of services delivered to a patient. Cost of patient treatment: Each treatmen t or basket of services is: Many P x Q in : P i x Q i (Sum of P x Q) Drugs: P x Q Dr. Salaries: P x Q Nurse Salaries: P x Q Other Materials: P x Q Etc. Etc. - P x Q n Services / activities 15 15

16 Treatment Treatment: Total Expenditure = Total treatments delivered. Total treatments delivered = Number of Patients x Treatment cost per patient

17 Clinical records - Patients Folders research Retrospective analysis of Clinical records (patients folders). Multidisciplinary team: Doctor, Nurse, Economist, Administrator, etc. Weakness: time and resources consumed. Strength: if conducted correctly = accurate

18 Average treatment Average treatment according to experts. (Must be a realistic average treatment). Weakness: not includes efficiency problems, may differ from actual expenditure. Strength: availability

19 Expenditure Estimations If necessary work with samples and then extrapolate to Universe. Statistical tools. Check results with expert (epidemiological, Dr s, etc), in order to validate hypothesis

20 Estimating Expenditures To define a strategy, first understand the Chain of transactions: ASC What is it paid?* Who pays? (Public and Private sector) Who provides? (Public and Private sector) Condom social marketing. Condom and campaign NGO s, Bilateral, Multilateral, etc NAP, NGO s, etc. Public and commercial sector condom provision. Condom User (Households, OOPE) or donor if subsidized or both. Pharmacies, NGO s, Hotels, Motels, etc. Provider initiated testing. Test cost (reactive and others) User, NGO s, MoH, etc Public and Private labs or clinics. Outpatient Opportunistic infections prophylaxis. Consult, drugs MoH, NGO s, Patient (PLWA), etc. Ambulatory care centers, public or private. Antiretroviral therapy. ARV (drugs cost of supply logistics) MoH, NAP, International donors, NGO s, Patient (PLWA), etc. Pharmacies, Ambulatory centers public or private *: Check definition in NASA Notebook

21 Estimating Expenditure NASA: Building a puzzle Always check the logic of the results Continuous work, don t loose time Always explain your estimations. Explain how, the way, you reach them Whenever you need to use assumptions, or whatever limitations you know your estimation has: clearly state it in your report

22 Examples 4 examples: Condoms Treatment - STI ARV Testing 22 22

23 CONDOMS Sources of information: Public: MoH, NAP, NAC. Private: Condoms imports (customs, companies), Market share, interviews. Condoms for Family Planning: not for AIDS prevention! 23 23

24 CONDOMS Private & Public Condoms Private Condoms Prices: Market Prices Consumer Price (Pharmacies) Public Condoms Prices: Price for MOH Social Marketing (Private & Foreign or Public) 24 24

25 CONDOMS Table 1. Condoms Private expenditure Private Condoms Units Un Average Price BBD Total Exp. BBD $0,86 $ $0,76 $ Table 2. Condoms Public expenditure NAP Condoms Units Average Price BBD Total Exp. BBD $0,64 $ $0,64 $

26 STI - Example Average treatment according to experts

27 STI Treatment Expert consultation average treatment STD Treatment Consultation Sexual Partner Doze Drugs Expend. Salaries Expend. Treatment Cost Number of cases Total Expend. Gonorrhoea CIPROFLOXACIN 500 mg 1 doze. Cost BBD 0,1157 in 50% of the cases; CEFTRIAXONE 125 mg. Intramusculare, single doze. 50% cases. Cost BBD 1,5. 1 Serynge BBD 0,38 1st. 15 min w/house Syster (precounselling for syphilys test & encourage VCT) + 25 min w/doctor; 2nd. visit 10 min w/house Sister + 10 min Doctor. In 20% of the cases the partner also takes CIPROFLOXACIN 500 mg 1 doze (most of the partners also visit the Doctor) $1,0 $26,4 $27,5 48 $1.307 Syphilis BENZATHINE PENICILLIN G 2,4 million units, single doze (+ cost of 1 serynge) 60% of total cases. BBD 0,9124 per doze; BENZATHINE PENICILLIN G 2,4 million units, three dozes (+ cost of 3 serynge) 40% of total cases. (Patients beeing tested positive two consecutive years). 1 Serynge BBD 0,38 3 consults. Total time 30 min House Sister + 30 min Doctor - $2,8 $25,7 $28,5 102 $2.901 Candidiasis Anti Fungus CLOTRIMAZOLE 1 tube BBD 3,5-90%; MYCORIL Ovules BBD 2,29-10% 2 consults, total time: House Sister 20 min, Doctor 40 min - $3,38 $27,2 $30,5 824 $ Bacterial Vaginosis METROGEL BBD 18,85 1 tube 3 consults, total time: 20 min House Sister, 30 min Doctor. - $18,85 $22,1 $41,0 623 $ Trichomynas is METRONIDAZOLE 200 mg, 10 tabs, each Tab BBD 0, TINIDAZOLE 500 mg 4 tabs x BBD 0, consults, total time: House Sister 15 min, 30 min Doctor 100% of cases partner also takes one doze. $1,13 $20,4 $21,5 208 $4.465 Lower Abdominal Pain AZITHOMYCIN 1 g oral doze BBD 1, DOXYCICLINE 100 mg 2 pills daily x 7 days total cost: BBD 10,00; Pain killer: Parecetamol 8 a day x 14 days (Parecetamol average price BBD: 0,01275 per tablet) 4 consults, total time: 25 min House Sister, 40 min Doctor 100% of cases partner also takes one doze. $24,64 $28,9 $53,6 277 $ Genito ulcer disease ACYCLOVIR 400 mg x 3 per day x 5 days BBD 0, 20 per tablet; Pain killer: Parecetamol 8 a day x 10 days (Parecetamol average price BBD: 0,01275 per tablet) 3 consults, total time: 20 min House Sister, 35 min Doctor. - $10,02 $24,7 $34,7 104 $3.601 Genital Warts - 6 consults, total time 30 min House Sister, 60 min Doctor. - TOTAL $0,00 $61,83 $40,7 $216,1 $40,7 $278, $1.693 $

28 STI STDs Estimation of Other STDs Data Used on STD Expenditure Estimation Estimati on 03 or 04 Gonorrhoea Syphilis Other STDs % Period Year Month Doctor salary $ $5.295 Nurse Salary $ $3.752 Candidiasis Bacterial Vaginosis Trichomynasis 40% 30% 10% Day Hour Minute $241 $30,08 $0,50 $171 $21,32 $0,36 Lower Abdominal Pain 13% 277 Genito ulcer disease 5% 104 Genital Warts 2% 42 (Estimation Data) 28 28

29 ARV Hospital A 2004 ARV Consumption Total Qty Un Price $ Total Exp. $ Combivir (zidovudine/lamivudine) AZT/3TC 35 $137,62 $ TC liquid 74 $24,43 $1.808 Sustiva TM (efavirenz/stocrin) 36 $43,07 $1.551 Retrovir Syrup 122 $40,12 $4.895 Zovirax susp. (12 x 125 ml, 32 x 125 ml) 32 $68,90 $2.205 Videx (didanosine) 100 mg 20 $34,40 $688 stocrin 20 $179,90 $3.598 Crixivan (indinavir sulfate) 15 $209,18 $3.138 ZiagenTM (abacavir sulfate) 1 $272,94 $273 Viramune (nevirapine) 200 mg 44 $82,57 $3.633 Ziagen TM (abacavir sulfate) 39 $99,43 $3.918 Retrovir (zidovudine) (IV) 1 $465,69 $466 Total 439 $

30 ARV - Statistics ARV LRU patients HAART LRU patients MTCT Mothers

31 MONITORING TESTS Laboratory A Qty. Unit cost $ Tests CD $48,8 $48,8 Viral Loads $126,8 $126,8 AIDS Tests $6,0 $8,0 Blood Banks tests $6,0 $8,

32 Quality Of The Estimations & Data Processed NASA NASA assessments assessments should should be be engaged engaged on on a process process of of continuum continuum improvement improvement on on its its Precision / Precision / Accuracy Accuracy (Nevertheless, the policy maker must not wait to have a NASA study with accurate estimations up to the last penny to use the tool for improving the management of the resources. Even not perfect estimations are more than good enough as a starting point.) 32 32

33 Thank you! 33 33