Importance of Cost and Cost-Effectiveness Analysis in TB/HIV Activities

1. Cost and cost-effectiveness data collection and indicatorsfor TB/HIV activities

2. What are we talking about? • Cost analysis • Measures total resources used • Measures average costs which is total costs by total units of service outputs • e.g. cost of VCT/ number attending VCT services • Cost-effectiveness analysis • Comparison of costs and outcome/impact achieved • Cost per outcome: cost of VCT/number people post-test counselled • Cost per impact: cost of VCT/number of HIV infections averted • Cost-benefit • costs and benefits described in money terms

3. What should the focus be? • Cost and cost-effectiveness analysis • Not cost-benefit • Complex • Is not necessary to answer priority/relevant questions that are being asked

4. Why is cost analysis important for TB/HIV? • Assess affordability of interventions • To inform budgeting and financial planning • For continued implementation and scaling-up • For introduction of programmes in new sites • To identify areas for improve efficiency of delivery of services and cost-savings • Relative cost of different activities and different delivery models • Multi-site comparison of average costs is important

5. Why is cost-effectiveness analysis important? Resources limited so: • Priority setting among different health interventions • Identifying efficient modes of delivery

6. Possible indicators by activity area

7. Possible Indicators by activity (2)

8. Possible Indicators by Activity (3)

9. What should be done, where and how often??? • NONE of these indicators on a routine basis • Routine: Financial expenditure by line item annually on district/project basis • THIS IS NOT SUFFICIENT FOR COST AND COST-EFFECTIVENESS ANALYSIS • Line items do not match intervention/activity area • Does not include non-financial inputs used

10. Priority indicators to measured in selected sites • Criteria for choosing priority indicators and sites • Indicators: insufficient evidence at national and global levels • Accounts for relatively large share of TB/HIV of costs • Feasible to collect relevant data (including effectiveness data) • Mix of countries (reflecting cost structures); mix of districts within countries (rural-urban) and scale of activity (pilot/phase 1, national) • Data considered relevant to national and global policy-making

11. Priority Indicators – Cost Analysis • All listed cost indicators in selected scaled-up programmes and selected sites in new countries • No data • Costs will be different from pilot sites • Countries need to know about affordability financing implications

12. Priority Indicators – CE Analysis (selected countries and selected sites) • VCT: cost per HIV infection averted (but needs behavioural survey, or RCT) • IPT: cost per person completing treatment – looking at trade-offs between increasing costs and increasing adherence • CPT: cost per person completing • Coordination: cost per additional referrals

13. Routine data collection for priority indicators • Although all indicators will not be monitored on a routine basis, there is need for routine data collection in selected sites in order to measure priority indicators

14. Routine data collection needed • Maintain financial expenditure records and inventory lists • List of donated items with quantities (including volunteer time) • Volume of activities: e.g. number of people visiting VCT per month • Cohort analysis: to track IPT and CPT completion • Measured periodically:Staff time spent on different activities