20th International AIDS Conference - Melbourne, Australia


WEPE402 - Poster Exhibition

The cost of treating children: evidence from Zambia

J. Waldron1, A. Adesina2, S. Alkenbrack1, S. Forsythe2, A. Amzel3, B.R. Phelps3, M. Bweupe4

1Health Policy Project, Futures Group, Washington, United States, 2Health Policy Project, Futures Institute, Glastonbury, United States, 3United States Agency for International Development, Washington, United States, 4Zambia Ministry of Health, Public Health and Research, Lusaka, Zambia

Background: To better plan for a sustained scale-up of treatment services, it is necessary to understand the costs of that treatment. USAID | Health Policy Initiative, Costing Task Order, funded through PEPFAR, examined the annual incremental cost (i.e., the cost of adding clinical pediatric ART services to an existing infant and well-baby service delivery platform) for children living with HIV in Zambia.
Methods: Facility cost and service data were collected from ten health facilities (which include secondary hospitals and urban and rural health centers). Unit costs were calculated for three age ranges of pediatric ART services: 0-23 months, 2-4 years, and 5-15 years. Cost data were further disaggregated into components (labor/personnel, drugs, HIV tests and medical supplies, operations/maintenance and capital), to identify major drivers.
Results: The average annual incremental cost of providing pediatric ART services in Zambia was calculated to be US$220. By facility type, the incremental cost was highest at rural health centers (US$260), followed by hospitals (US$228), and urban health centers (US$176). In terms of subcategories, across all types of facilities, "drugs, consumables and medical supplies" are the largest portion of the unit cost at 32 percent of total unit cost. This is followed by staff training (26%), overhead costs (23%), vehicles and equipment (13%) and direct staff costs (5%). When cost data were disaggregated by urban and rural designation, the cost of pediatric ART services was higher for facilities that operate in rural areas (US$226) than urban areas (US$203). The average incremental cost of pediatric ART services from this study was lower than the combined cost of pediatric ART services and other infant and child services which were estimated in a previous study conducted in Zambia.
Conclusions: Understanding the incremental cost of providing pediatric ART services is crucial to improving the accuracy of cost estimates of a national HIV and AIDS strategy for Zambia. The study documents actual costs, but does not reflect the quality of care being provided to pediatric patients. Future studies that look at quality of care will be crucial to understanding and thus estimating the true cost of meeting the needs of children living with HIV.

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