training program costing example - university of washington · training program costing example...
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Trainingprogramcostingexample
MarciaWeaver,PhDResearchAssociateProfessor
InstituteforHealthMetricsandEvaluation(IHME)October13,2016
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Learningobjectives
Following this session, participants will:
1. Correctly explain how five principles of cost analysis can be applied to a training program
2. Interpret results of the cost-effectiveness analysis for the Integrated Infectious Disease Capacity-Building Evaluation (IDCAP)
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1.Perspective
Perspective isthepointofviewfromwhichthecostsare
calculated.Itaddressestheissueofwhichinputsor
resourcestoinclude.
• Trainingprogrambudgetforyourorganization
• Donor,whichincludesotherpartnerstheysupport
• Societal,whichincludesopportunitycosts
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Costperunit
5-daycomputer-basedtraining plus3-dayworkshop
10-day trainingpluson-sitevisits
Units Cost Units Cost
Trainer $100 per
day
3 $300 10 $1,000
On-site $1,000
persite
0 5 $5,000
[..]
Training
program
budget
$7,350 $12,250
Trainingprogrambudget
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Costperunit
5-daycomputer-basedtraining plus3-dayworkshop
10-day trainingpluson-sitevisits
Units Cost Units Cost
Training
program
budget
$7,350 $12,250
Hotel
contract
$225 per
day
3 $675 10 $2,250
Donor
cost
$8,025 $15,000
Donorperspective
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Costperunit
5-daycomputer –basedtraining plus3-dayworkshop
10-day trainingpluson-sitevisits
Units Cost Units Cost
Trainingpro-
grambudget
$7,350 $12,250
Contract with
venue
$225
perday
3 $675 10 $2,250
Trainees’time $20 per
day
200 $4,000 275 $5,500
Total cost $12,025 $20,000
Societalperspective
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Costperunit
5-daycomputer –basedtraining plus3-dayworkshop
10-day trainingpluson-sitevisits
Units Cost Units Cost
Trainingpro-
grambudget
$7,350 $12,250
Contract with
venue
$225
perday
3 $675 10 $2,250
Trainees’time $20 per
day
200 $4,000 275 $5,500
Total cost $12,025 $20,000
Cost/trainee 25 $481 25 $800
Societalperspective
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2.Financialvs.economiccostFinancial cost – For goods and services that are traded on a competitive market, the opportunity cost is simply the price
where opportunity cost is the value of the most beneficial alternative use of the resources.
Economic cost – Value of goods and services that are not purchased such as volunteer time or for which the price is distorted
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3.Outputvs.outcome
1. The cost per unit of output is valid when the two programs being compared are equally effective.
2. A cost per unit of outcome can address differences in effectiveness across programs.
3. The scope of the analysis is determined by the denominator. Only programs with a common denominator can be compared.
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Costperunitofoutput
5-daycomputer-basedtrainingplus3-dayworkshop
10-daytrainingpluson-site
Costoftransferoflearning
Training $12,025 $20,000
Supervision $8,000 $2,000
Totalcost $20,025 $22,000
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Costperunitofoutput
5-daycomputer-basedtrainingplus3-dayworkshop
10-daytrainingpluson-site
Costoftransferoflearning
Training $12,025 $20,000
Supervision $8,000 $2,000
Totalcost $20,025 $22,000
Costper trainee $20,025/25 =$801 $22,000/25=$880
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Costperunitofintermediateoutcome
5-daycomputer-basedtrainingplus3-dayworkshop
10-daytrainingpluson-site
Costoftransferoflearning
Training $12,025 $20,000
Supervision 8,000 $2,000
Totalcost 20,025 $22,000
Traineeswhomeetstandard 15 22
Costpertraineewhomet
standard
$20,025/15=$1,335 $22,000/22 =$1,000
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Costanalysis:Comparesthecostperunitofoutputwhentoprogramsareequallyeffective
Cost-effectivenessanalysis(CEA):Comparescosttoeffectiveness,e.g.• Clinicianwhomeetsstandard• $/lifeyearssavedfromintervention
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4.Incrementalanalysis
Incremental cost effectiveness ratio (ICER)
Δ Change in health care cost
Δ Change in health outcomes
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ICERisaslope
HealthCareCost
Healthoutcomes Health
Benefits
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PMTCTCost/HIVinfectionavertedPre-training Post-training
Programcost
Remuneration $80,000 $84,000
Supplies 15,000 18,000
Capital 5,000 10,000
TotalCost $100,000 $112,000
Number ofmother-infantpairs 1,000 1,200
Basecase-verticaltransmission 25% 25%
NumberofHIVinfectionsaverted 1,000*.25*.63=158 1,200*.25*.63=189
Incrementalcost $112,000- $100,000=$12,000
Incrementaleffectiveness 189 – 158=31
ICER $12,000/31=$381
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4.Incrementalanalysis
Effects:HIV
infections
averted
HealthCareCost
189
158
$100,000 $112,000
ICER
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5.Sensitivityanalysis
• Calculationofalternativecost-effectivenessresultswhenthereisuncertaintyaboutoneormoreparameters.
• Itshowstheextenttowhichuncertaintyaboutaparameterwouldsubstantiallyaffecttheestimate.
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PMTCTCEAwithuncertainty
Pre-training Post-trainingTotalCost $100,000 $112,000
Number ofmother-infantpairs 1,000 1,200
Basecase-verticaltransmission 25% 25%
Lowerbound 19% 19%
Upper bound 30% 30%
Incrementalcost $112,000- $100,000=$12,000
ICER– base case $12,000/31=$381
Lowerbound $12,000/24=$501
Upperbound $12,000/38=$317
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1.Perspective
2.Financialvs.economiccost
3.Outputvs.outcome
4.Incrementalanalysis
5.Sensitivityanalysis
Summary– 5principles
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• DevelopanIntegratedManagementofInfectiousDisease(IMID)curriculumformidlevelpractitioners• ComplementthetrainingprogramwithOn-SiteSupport(OSS)• Measuretheireffectonthequalityofcareandhealthoutcomes• Estimatethecost-effectivenessoftheinterventions
Aim:Create& evaluateaninnovativecapacity-building
program
PhotobyCharlesSteinberg,MD
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IntegratedManagementofInfectiousDisease(IMID)
•WHOcurriculasuchasIMCI,ETAT,andIMAI
•Advancesinhealthprofessionaleducation(Miceli,etal.IJID2012)
• HIV,TB,malaria,andpneumonia
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On-SiteSupport(OSS)MobileTeam
•Medicalofficer
•ClinicalOfficer
•LaboratoryTechnologist
•Districtcontactperson/nurseofficer
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MixedDesignWithPre/PostandCluster
RandomizedTrialComponents
ARMBIMID
OSS
ARMAIMID
OSS
Time0Time1Time2
Bi-monthlyOSS
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23Facilityperformanceindicatorsspannedsevenareas
• Emergencytriage,assessmentandtreatment(ETAT)• Casemanagementoffever• HIVprevention• HIVCare• ART• Respiratoryillness• TB/HIV
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Exampleofresults:Percentageofoutpatientstriaged
Time0:ArmA
Time0:ArmB
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%ofOutpatientsTriaged
RR(CI)Arm A
Time1– Time0 2.03(1.13,3.64)*Arm B
Time1– Time0 1.29(1.01,1.64)*Arm Avs.ArmB: Time1– Time0 1.58(0.82,3.01)
OSSsignificantlyincreasedthe% ofoutpatientstriaged
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Analysisfor23indicatorsshowedimpacton6indicators
• Outpatientstriaged
• Emergency&prioritypatientsadmitted,detainedorreferred
• Malariasuspectsreceivedappropriatetreatment
• Smearnegativemalariasuspectstreatedw/anti-malarials
• U5pneumoniasuspectsassessedforpneumonia
• HIVinfectedpatientsenrolledincare
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CostAnalysis
Intervention
• CurriculumDevelopment• IMID• On-siteSupport
Treatment
• Drugs
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Preliminarycostanalysisin$US
IMID+OSS(ArmA)
IMID(ArmB)
IncrementalcostofOSS
GrantCurriculum $16,994 $12,610IMID 22,047 22,0470SS 49,230Total $88,271 $34,656MOHSalariesIMID $464 $456OSS 533Total $997 $456Malariadrugsavings (523) (77)Netcost $88,745 $35,036 $53,709
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IntegratedEpidemiologicalModel
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Malaria&PneumoniaModel
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IMID+OSS IMID Incre-mental
Netcost $88,745 $35,035 $53,710
Livessaved 23 15 8
$/Life $3,875 $2,336 $6,799
DALYsSaved 729 484 245
$/DALY $122 $72 $219
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Summary- IDCAP
• Integratedepidemiologicalmodelcombinesmostindicatorstoprovideoneaggregatemeasureoftheeffect IMIDandOSSacrossthreeagegroups.
• Uganda’sGDPin2011wasroughlyUS$487percapita,suggestingIMIDandOSSwerehighlycost-effectiveinterventionsbothindividuallyandincombinationbyWHOstandards.
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Thankyou!