SWA regional meeting

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SWA regional meeting
Value for money practical challenges

• Hyderabad, 9-11 October, 2009

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Apply (VFM) with care.

• GF grant costing versus program costing
• Costing benchmarks very helpful
• Lower level v higher level analysis
• Different programs need different measurement
• Quality aspect its not just about per
  output...but hardest to measure

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Example 1 Cost effectiveness of TB program in
India

• Total costs of TB control per capita is US 0.1
  (2007)
• Cost of first line drugs per patient treated in
  India is US 14 compared to US 30 (median) for
  HBCs
• India remains the country with the lowest cost
  per patient treated (US 84) compared to US
  274 (median) for HBCs

How could/should we use this information?
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Example 2 Value for money - Bangladesh

• Rd 6 HIV grant USD40m lifetime budget
• Program is an ambitious scale up of HIV
  prevention, treatment, care support activities
• Phase 2 request discussed at the panel
• Q Is a USD40m 5-yr investment in a country with
  low prevalence (lt0.1) good value for money?
• A when put in context of the entire national
  population of 153m it seems good value.but then
  how do we really know

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Example 2 Value for money - Bangladesh

• From the bottom up
• SDA essential harm reduction services for IDUs
• how could we determine value for money?
• Does a reasonable unit cost value for money?
• What else can we refer to..?

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Example 2 Value for money - Bangladesh

• Moving up the pyramidHow much/how many IDUs do
  PEs reach and at what cost?
• What can this tell us about value for money of
  the activity???

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Questions
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Levels of Value for Money measurement
Cost per life-year saved or DALY gained by
ART, ITN, DOTS
Cost per outcome Cost per ITN hung Cost per
patient cured through DOTS
Key services ART DOTS ITNs
Per-person service (output) cost Cost per
patient-year of ARTCost per patient treated with
DOTSCost per ITN delivered
First phase (2008?)
Health product unit cost Price per ARV
tablet/packPrice per Olyset ITN (through GF-PQR
WHO- GPRM)
See Global Fund Value for Money framework, April
2008