Title

Filling in the gaps: Extrapolating VMMC unit costs using aggregated primary data from several studies

Presenter

Carlos Pineda-Antunez

Authors

S. Bautista-Arredondo¹, C. Pineda-Antunez¹, D. Cerecero-Garcia¹, S. Forsythe², M. Tchuenche², J. Kahn³, A. Vassall⁴, V. Mennon⁵, L. Alexander⁶, C. Chiwevu⁵, K. Kripke⁷, C. Levin⁶, L. Bollinger²

Institutions

¹National Institute of Public Health in Mexico, Health Economics and Health Systems Innovation, Cuernavaca, Mexico, ²Avenir Health, Glastonbury, United States, ³University of California San Francisco, San Francisco, United States, ⁴London School of Hygiene and Tropical Medicine, London, United Kingdom, ⁵HPI Costing Task Order, Washington, United States, ⁶University of Washington, Seattle, United States, ⁷Avenir Health, Washington, United States

Background: The policy-relevance of cost information hinges on it being provided in a timely fashion. But cost studies are expensive and slow to implement, meaning this type of evidence is not available at moments of critical decision-making. The objective of this work is to combine data on costs of VMMC services from several independent studies, to identify determinants of VMMC costs and extrapolate costs to areas where there is absence of information.
Methods: We identified high-quality VMMC cost studies through a literature review. Authors were contacted to share their data on costs and service delivery characteristics. We standardized the disparate datasets into an aggregated database which included 228 facilities in eight countries. We estimated VMMC unit costs (or average cost per circumcision). We conducted OLS regression models to estimate the effect of the determinants of unit cost variation across sites. Based on cluster analysis, we extrapolated unit cost to different implementing scenarios, including countries out of our sample and different levels of scale.
Results: The average unit cost was 73 USD (IQR: 28.3, 100.7). South Africa showed the highest within-country cost variation, as well as the highest mean unit cost (135 USD). Uganda and Namibia had minimal within-country cost variation, and Uganda had the lowest mean VMMC unit cost (22 USD). Our results showed evidence consistent with economies of scale. Private ownership and Hospitals were significant determinants of higher unit costs. By clustering countries with similar economic, epidemiologic and demographic indicators, and through multivariate extrapolations, we extrapolated unit cost to countries without available cost data.
Conclusions: Our results showed large variation in VMMC unit costs across and within countries. We identified several facility-level characteristics significantly associated with VMMC unit costs across implementation and country contexts. Our findings contribute to improving the availability of cost evidence, even for those countries with no previous studies, in order to increase the efficiency of service delivery.