Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

BMC Health Services Research

Galina Lesco¹  Evert Ketting³  Jari Kempers² 

[1] Youth-Friendly Health Centre Neovita, Health for Youth Association, 19, Socoleni Str., MD 2020 Chisinau, The Republic of Moldova;Qalys Health Economics, Middenweg 239 I, 1098AP Amsterdam, The Netherlands;Nijmegen International Centre for Health Systems Research and Education (NICHE), Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, The Netherlands

关键词: Cost-effectiveness;    Scale-up;    Cost;    Prevention;    Reproductive health;    Sexual;    Centre;    Youth-friendly;    Adolescent;   

Others  :  1127049
DOI  :  10.1186/1472-6963-14-316

 received in 2013-10-11, accepted in 2014-07-09,  发布年份 2014

【 摘 要 】

Background

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective?

Methods

Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving).

Results

Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections.

Conclusions

The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies.

【 授权许可】

   
2014 Kempers et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]The National Bureau of Statistics of the Republic of Moldova: Population Statistics. 2013. [http://statbank.statistica.md/pxweb/database/EN/databasetree.asp webcite]
• [2]The United Nations Children's Fund Regional Office for CEE/CIS: Transformative monitoring for enhanced equity database. Incidence of sexually transmitted diseases in population aged 15–19 years in Moldova. 2013. [http://www.transmonee.org/index.html webcite]
• [3]The National Bureau of Statistics of the Republic of Moldova: Abortions in the age group 15–19 years, 1995–2011. 2011. [http://statbank.statistica.md/pxweb/database/EN/databasetree.asp webcite]
• [4]Venkatraman CM, Baltag V, Ogbaselassie L: Strategies to sustain and scale up youth friendly health services in the Republic of Moldova. BMC Public Health 2013, 13:284. BioMed Central Full Text
• [5]The Ministry of Health of the Republic of Moldova: Order No. 349 of 15.10.2009 Report No. 49, annual report 2012. 2012.
• [6]Mosin V, Ciubotaru V, Lesco G: Quality standards of youth friendly health services in the Republic of Moldova. Chisinău: The Ministry of Health of the Republic of Moldova; 2009. [http://old.ms.md/public/info/Ghid/standarte/rm/ webcite]
• [7]The United Nations Children's Fund: Quality of YFHS. Baseline evaluation report. Chisinău: UNICEF (The United Nations Children's Fund); 2009.
• [8]Currency Me UK: Exchange rate on 31 December 2011: 1 USD = 11.7164 Moldovan Lei. [http://www.currency.me.uk/convert/usd/mdl webcite]
• [9]The Ministry of Health of the Republic of Moldova: Order No. 347 of 29.04.2011 "On approval of cost of treated cases in 2011". 2011. Ordinul Ministerului Sănătății Republici Moldova nr 347 din 29.04.2011”Cu privire la aprobarea costurilor cazurilor tratete pentru 2011”. [http://www.ms.md/sites/default/files/legislatie/ordinul_nr._347_din_29.04.2011.pdf webcite]
• [10]Lesco G, Malcoci L, Luchian A, Baciu T: Adolescent Health and Development. Knowledge, attitudes and practices study. Chisinău: Health for Youth Association, preliminary report; 2013.
• [11]The National Bureau of Statistics of the Republic of Moldova: Abortions and fertility by age group and year. 2012. [http://statbank.statistica.md/pxweb/database/EN/databasetree.asp webcite]
• [12]The Medicines and Medical Devices Agency: The national catalogue of medicine prices. 2013. Agentia medicamentului si dispozitivelor medicale. Catalogul national de preturi de producator la medicamente. [http://www.amed.md/?new_language=0&go=page&p=143 webcite]
• [13]Bordescova L: Medico-social aspects of pregnancies and teenage births in Moldova. Chisinău: The State University of Medicine and Pharmacy; 2005. [PhD thesis] Aspectele medico-sociale ale sarcinii şi naşterii la adolescente în Republica Moldova. Adnotare la teza de doctor. Universităţii de Stat de Medicină şi Farmacie. Tezei de doctor în medicină Chisinău 2005 [http://www.cnaa.acad.md/thesis/1774/ webcite]
• [14]National Scientific and Applied Center for Preventive Medicine: Moldova Demographic and Health Survey 2005. Chisinău: The Ministry of Health of the Republic of Moldova; 2006.
• [15]The Joint United Nations Programme on HIV/AIDS Moldova: Report on assessment of Expenses for Antiretroviral Therapy for People Living with HIV and AIDS. 2012.
• [16]Fang CT, Chang YY, Hsu HM, Twu SJ, Chen KT, Lin CC, Huang LY, Chen MY, Hwang JS, Wang JD, Chuang CY: Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy. QJM 2007, 100(2):97-105. 10.1093/qjmed/hcl141
• [17]The National Institute for Health and Clinical Excellence: Guide to the Methods of Technology Appraisal. London; 2008. [https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/191504/NICE_guide_to_the_methods_of_technology_appraisal.pdf webcite]