The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India

Chandrashekar, Sudha; Guinness, Lorna; Kumaranayake, Lilani; Reddy, B N; Govindraj, Y; Vickerman, Peter; Alary, Michel

doi:10.1136/sti.2009.038547

Cited by 26 publications

(30 citation statements)

References 20 publications

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“…Yet, economies of scale have been found to exist in HIV prevention programmes (Dandona et al. 2008; Chandrashekar et al. 2010) and are likely to be important for cost‐effectiveness analyses informing decisions on different cervical cancer prevention strategies.…”

Section: Discussionmentioning

confidence: 99%

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

Quentin

Adu‐Sarkodie

Terris‐Prestholt

et al. 2011

Tropical Med Int Health

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ObjectivesTo estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs.MethodsResource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs.ResultsIncremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy.ConclusionWhen choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern.

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Section: Discussionmentioning

confidence: 99%

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

Quentin

Adu‐Sarkodie

Terris‐Prestholt

et al. 2011

Tropical Med Int Health

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“…Based on previous literature (Meyer‐Rath and Over ; Siapka et al, ; Dandona et al, ; Chandrashekar et al, ; Guinness et al, ; Guinness et al, ; Kumaranayake and Watts, ; Marseille et al, ; Menzies et al, ; Rosen et al, ), several potential categories of determinants of average cost were explored. The justification of covariates in each of these six categories is detailed in Table .…”

Section: Methodsmentioning

confidence: 99%

“…Following this, to include extreme values and also remove skewness in the residuals, the average unit costs were log transformed. Based on previous literature (Meyer-Rath and Over 2012; Siapka et al, 2013;Dandona et al, 2005;Chandrashekar et al, 2010;Guinness et al, 2005;Guinness et al, 2007;Kumaranayake and Watts, 2000;Marseille et al, 2007a;Menzies et al, 2012;Rosen et al, 2008), several potential categories of determinants of average cost were explored. The justification of covariates in each of these six categories is detailed in Table II. Regarding the functional form, we tested a logarithmic form versus a quadratic functional form.…”

Section: Model Specificationmentioning

confidence: 99%

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

et al. 2016

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Expanding essential health services through non‐government organisations (NGOs) is a central strategy for achieving universal health coverage in many low‐income and middle‐income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost‐effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed‐effect panel estimator and a random‐intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant‐based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

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“…Costs were obtained from NGOs, state level partners and the Bill and Melinda Gates foundation and are described in Chandrashekar et al (2010). Costs include recurrent costs (personnel costs, project building and operating expenses, travel expenses, STI supplies, monitoring cost, information education & communication, training, condom supplies and indirect expenses) and capital costs (rent, equipment, furniture, vehicle, initial training, insurance and deposits, and start up cost).…”

Section: Descriptive Statisticsmentioning

confidence: 99%

Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan

Lépine

Vassall

Chandrashekar

et al. 2015

Social Science & Medicine

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Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good 'value for money'. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries.

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The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India

Cited by 26 publications

References 20 publications

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan

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