Using Top-down and Bottom-up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale

Health Economics
Lucy CunnamaAnna Vassall

Abstract

Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective,...Continue Reading

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Citations

Jun 20, 2017·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Zhuoyu WangLawrence Joseph
Sep 24, 2020·Australasian Journal on Ageing·Tracy ComansMeera Agar
Feb 6, 2017·American Journal of Clinical Pathology·Kenneth A FlemingNestor Lago
Jun 23, 2018·Global Health Research and Policy·Samuel I WatsonRichard J Lilford
Feb 13, 2020·Revista Da Sociedade Brasileira De Medicina Tropical·Valéria Martins SoaresSilvana Spindola de Miranda
May 25, 2018·Harm Reduction Journal·Jose Luis BurgosNatasha K Martin
Oct 1, 2020·The American Journal of Tropical Medicine and Hygiene·Paola SalariFabrizio Tediosi
Jan 3, 2021·International Journal for Equity in Health·Anthony SsebagerekaElizabeth Ekirapa-Kiracho
Nov 30, 2020·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Gabriela B GomezAnna Vassall
Feb 3, 2021·PloS One·Lelisa Fekadu AssebeAmanuel Yigezu
Feb 15, 2021·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Joanna JędrzejczakBrian Godman
Jul 5, 2021·BMC Public Health·Assegid G HelleboOlufunke Alaba
Dec 16, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Laura T R MorrisonNorman Goco

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Software Mentioned

Excel
OneHealth Tool
XTEND
stata

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