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HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries.

Marseille E, Dandona L, Marshall N, Gaist P, Bautista-Arredondo S, Rollins B, Bertozzi SM, Coovadia J, Saba J, Lioznov D, Du Plessis JA, Krupitsky E, Stanley N, Over M, Peryshkina A, Kumar SG, Muyingo S, Pitter C, Lundberg M, Kahn JG - BMC Health Serv Res (2007)

Bottom Line: The fraction of variation in efficiency explained by scale ranged from 26-96%.Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%).Unit costs decrease with scale across a wide range of service types and volumes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health Policy Studies, University of California, San Francisco, USA. emarseille@comcast.net

ABSTRACT

Background: Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.

Methods: The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R2).

Results: Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26-96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased.

Conclusion: Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.

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Mentions: For VCT, data from all five countries show strong scale effects, i.e., sites with higher service volume tend to have lower unit costs (See Figure 1). Scale varied 100-fold within countries, and 1,000-fold across the full sample. Efficiency (cost per person receiving full VCT) varies from 10-fold to more than 100-fold within country, and over all five countries varies from $668 (in Mexico) down to $1.50 (in Russia, where counseling may be just a few minutes). The proportion of variation explained by scale varied from 20% (Mexico) to 83% (India). In Mexico, each doubling in scale is associated with a drop of $30 per VCT client (7–27%, depending on starting point). In South Africa, the effect of doubling in scale is low until more than 10,000 VCT clients (with the curve shape driven by one large program). For India, Uganda, and Russia, a doubling in size is associated with 27% to 32% lower costs.


HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries.

Marseille E, Dandona L, Marshall N, Gaist P, Bautista-Arredondo S, Rollins B, Bertozzi SM, Coovadia J, Saba J, Lioznov D, Du Plessis JA, Krupitsky E, Stanley N, Over M, Peryshkina A, Kumar SG, Muyingo S, Pitter C, Lundberg M, Kahn JG - BMC Health Serv Res (2007)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1936993&req=5

Mentions: For VCT, data from all five countries show strong scale effects, i.e., sites with higher service volume tend to have lower unit costs (See Figure 1). Scale varied 100-fold within countries, and 1,000-fold across the full sample. Efficiency (cost per person receiving full VCT) varies from 10-fold to more than 100-fold within country, and over all five countries varies from $668 (in Mexico) down to $1.50 (in Russia, where counseling may be just a few minutes). The proportion of variation explained by scale varied from 20% (Mexico) to 83% (India). In Mexico, each doubling in scale is associated with a drop of $30 per VCT client (7–27%, depending on starting point). In South Africa, the effect of doubling in scale is low until more than 10,000 VCT clients (with the curve shape driven by one large program). For India, Uganda, and Russia, a doubling in size is associated with 27% to 32% lower costs.

Bottom Line: The fraction of variation in efficiency explained by scale ranged from 26-96%.Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%).Unit costs decrease with scale across a wide range of service types and volumes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health Policy Studies, University of California, San Francisco, USA. emarseille@comcast.net

ABSTRACT

Background: Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.

Methods: The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R2).

Results: Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26-96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased.

Conclusion: Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.

Show MeSH
Related in: MedlinePlus