|Cost-Effectiveness Tool for Evaluating Interventions to Prevent Mother-to-Child Transmission - Manual and Model (UNAIDS, 2000, 94 p.)|
This table provides a quick method for estimating VCT costs. It can be unmasked via a macro if you opt to use the summary method of evaluating VCT costs. Enter S for Summary in cell VCT C18. If D for Detailed in cell VCT C18 is selected this table is masked and you may proceed to Table VCT - 3 to enter more detailed information. In that case you may skip this section of the manual and proceed to page 27. This summary method is most appropriate if data are available from projects that focus on VCT for HIV or for projects in which the finances of the non-VCT activities are easily separable from the VCT services.
By dividing total monthly operating expenditures (including capital costs converted to a recurring cost basis), into the number of clients who complete VCT and register for the MTCT intervention, one can directly derive a per-client operating cost. The issues mentioned above such as how to treat research and other adjunct activities; start-up and seasonal effects; patient fees; and the sharing of joint resources apply to this summary costing approach as well. A shortcoming of this approach is that it does not permit differential accounting for the cost of HIV-negative versus HIV-positive clients. This could be useful for predicting cost changes if prevalence in the caseloads changed, or if the VCT program were transferred to an area with a different HIV prevalence. Another disadvantage of the summary costing approach is that, since one cannot document the cost of the various steps in the VCT sequence, it is far less useful for cost control purposes.
In cells D23 through F28 of Table VCT-2 you are asked to enter low, best and high estimates for each of six variables that determine total net annual costs of providing VCT to pregnant women in your service area.
Influence on cost-effectiveness: High. VCT costs can constitute up to 75% of total program costs.
Expected effort of data collection: Medium. You have chosen to enter summary estimates in order to reduce the effort of estimating VCT costs in detail. Some loss of accuracy is inevitable. Because VCT costs have such a strong influence on cost-effectiveness, it makes sense to review budget and expenditure documents and to interview relevant project personnel in order to arrive a reasonable data-based estimate.
D23-F23. Number of HIV-positive clients who complete VCT and register for MTCT intervention per year. Enter a low, best and high estimate for the number of HIV positive women you expect will complete VCT and register to receive an MTCT intervention, either ARVs or substitute feeding. Data sources: One way to obtain a quick estimate is to use last years figures and adjust them upward or downward to reflect the factors that might make future reality differ from past experience.
D24-F24. Variable costs. Enter a low, best and high estimate for the annual expenditures on items that vary with the number of patients seen. This includes both supply items such as test kits; and personnel items such as wages and benefits for counselors and lab personnel. Since test kits are likely to be a large part of total costs it makes sense to obtain a good estimate of these costs. Data sources: Project expenditure documents.
D25-F25. Fixed costs. Enter a low, best and high estimate for items that tend to remain the same over relatively large changes in program scale. These include administrative costs and rent. Some personnel may have both administrative and direct service duties. If so, divide their compensation expenses appropriately between variable and fixed costs. Data sources: Project expenditure documents.
D26-F26. Capital goods. Enter a low, best and high estimate for annual expenditures on durable items (those lasting over a year) such as furniture and office equipment that are being used for the MTCT-VCT activities. Data sources: Project expenditure documents.
D27-F27. Average life of capital goods. Enter a low, best and high estimate for the average length in years of the useful life of these capital goods. Data sources: None. Use your best judgment based on the current condition of the items and how intensively they will be used.
D28-F28. Patient revenues. Enter a low, best and high estimate for the annual revenues that you expect to receive from VCT clients. This could be in the form of registration and other fees or from voluntary donations. Data sources: Project financial documents.
I18 - P29. Result of VCT cost calculation using the summary approach. If C18 = S, this table displays the results of the summary calculation; if C18 = D it displays the results of the detailed calculation. In both cases it gives the low, best and high estimates for:
· Variable costs
· Patient revenues
· Net variable costs (variable costs minus patient revenues)
· Fixed costs
· Capital costs
· Total annual costs
· Cost per HIV-positive patient who completes VCT
The left half of the table shows these results assuming that there are no external benefits of VCT. The right side shows the results with whatever the current value in cell C5 is (external benefit of VCT). The figures on the right-hand side are operative in the cost-effectiveness calculation. If you wish to run the analysis assuming no external benefit of VCT, make sure 0% is entered in cell C5.