Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan

Raza, Wajeeha; Zulfiqar, Wahaj; Shah, Mashal Murad; Huda, Maryam; Akhtar, Syeda Shehirbano; Aqeel, Urooj; Kanwal, Saira; Khalid, Muhammad; Zaidi, Raza; Jansen, Maarten; Kitson, Nichola; Bijlmakers, Leon; Siddiqi, Sameen; Alwan, Ala; Vassall, Anna; Torres-Rueda, Sergio

doi:10.34172/ijhpm.2023.8006

Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan

Document Type : Original Article

Authors

Wajeeha Raza ¹

Wahaj Zulfiqar ²

Mashal Murad Shah ³

Maryam Huda ³

Syeda Shehirbano Akhtar ²

Urooj Aqeel ²

Saira Kanwal ²

Muhammad Khalid ²

Raza Zaidi ²

Maarten Jansen ⁴

Nichola Kitson ⁵

Leon Bijlmakers ⁴

Sameen Siddiqi ³

Ala Alwan ⁶

Anna Vassall ⁵

Sergio Torres-Rueda ⁵

¹ Centre for Health Economics, University of York, York, UK

² Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan

³ Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

⁴ Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands

⁵ Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK

⁶ DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK

10.34172/ijhpm.2023.8006

Abstract

Background
The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan’s EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process.

Methods
A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out.

Results
Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing.

Conclusion
We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.

Keywords

Costing

UHC

Benefit Package

Pakistan

United Nations Economic and Social Council (ECOSOC). Progress Towards the Sustainable Development Goals. New York: ECOSOC; 2017.
Glassman A, Giedion U, Smith P. What's in and What's Out: Designing Benefits for Universal Health Coverage. Washington, DC: Center for Global Development; 2017.
Government of Pakistan and Ministry of National Health Services Regulation & Coordination. National Discourse on the Development and Implementation of Universal Health Coverage Benefit Package of Pakistan. 2019.
Jamison DT, Alwan A, Mock CN, et al. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition. Lancet. 2018;391(10125):1108-1120. doi:1016/s0140-6736(17)32906-9
Watkins DA, Jamison DT, Mills T, et al. Universal health coverage and essential packages of care. In: Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington, DC: The International Bank for Reconstruction and Development, The World Bank; 2017.
Government of Pakistan and Ministry of National Health Services Regulation & Coordination. Coordination, Review of Essential Health Services Based on Disease Control Priorities 3. 2019.
Tufts Medical Centre. Global Health Cost Effectiveness Analysis Registry. 2019. http://ghcearegistry.org/ghcearegistry/.
Huda M, Kitson N, Saadi N, et al. Assessing global evidence on costeffectiveness to inform development of Pakistan’s essential package of health services. Int J Health Policy Manag. 2023;12:8005. doi:34172/ijhpm.2023.8005
Irving G, Neves AL, Dambha-Miller H, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902. doi:1136/bmjopen-2017-017902
Tijdens K, de Vries DH, Steinmetz S. Health workforce remuneration: comparing wage levels, ranking, and dispersion of 16 occupational groups in 20 countries. Hum Resour Health. 2013;11:11. doi:1186/1478-4491-11-11
Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240-249. doi:1016/s0140-6736(08)61762-6
Watson SI, Sahota H, Taylor CA, Chen YF, Lilford RJ. Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review. Glob Health Res Policy. 2018;3:17. doi:1186/s41256-018-0073-z
Vassall A, Sweeney S, Kahn J, et al. Reference Case for Estimating the Costs of Global Health Services and Interventions. Global Health Cost Consortium; 2017.
Oanda Smarter Trading. 2019. Available from: https://www.oanda.com/foreign-exchange-data-services/en/. Accessed July 15, 2019.
Sagheer U, Kielmann AA, Mumtaz Z, Shahab S. Cost of establishing and maintaining a bed in a tertiary care hospital in Pakistan. Leadersh Health Serv (Bradf Engl). 2000;13(2):1-6. doi:1108/13660750010326848
Khan RM, Albutt K, Qureshi MA, et al. Time-driven activity-based costing of total knee replacements in Karachi, Pakistan. BMJ Open. 2019;9(5):e025258. doi:1136/bmjopen-2018-025258
Government of Pakistan and Ministry of National Health Services Regulations & Coordination. Interventions’ Description of Essential Package of Health Services/IHC Benefit Package of Pakistan. 2020.
Torres-Rueda, S, Vassall A, Zaidi R. The use of evidence to design an essential package of health services in Pakistan: a review and analysis of prioritisation decisions at different stages of the appraisal process. Int J Health Policy Manag. 2023; In Press.
Ministry of National Health Services Regulations and Coordination. Federal Pay Scales for Health Workers Islamabad Capital Territory. 2019.
Government of Sindh, Health Department. Procurement of Drugs, Medicines, Surgical and Disposable Items, Xray files, Chemicals & Allied Items Under Rate Contract Basis During the Year. 2019.
Procurement Prices. Medical Emergency Resilience Fund. 2019.
Ministry of National Health Services Regulation and Coordination. Islamabad Capital Territory Health Infrastructure 2020-2021 PC-1. 2020.
Ministry of National Health Services Regulations and Coordination. Khyber Pakhtunkhwa Province Hospital Costing. 2019.
Terris-Prestholt F, Santos A, Sweeney S, et al. Guidelines for cost-effectiveness analysis of syphilis screening strategies. The Rapid Syphilis Test Toolkit. 2012. https://media.tghn.org/articles/IMPLEMENTATION_1.pdf.
Punjab Healthcare Commission. Costing and Pricing of Services in Private Hospitals of Lahore. Punjab Healthcare Commission; 2018.
Daniels N. Accountability for reasonableness. BMJ. 2000;321(7272):1300-1301. doi:1136/bmj.321.7272.1300
Medical Sciences for Health. Cost Revenue Analysis Tool Plus. 2017. Available from: https://www.msh.org/resources/cost-revenue-analysis-tool-plus.
Health Interventions Prioritization Working Group. Health Interventions Prioritization (HIP) Tool. 2019. Available from: http://hiptool.org/.
Eregata GT, Hailu A, Geletu ZA, et al. Revision of the Ethiopian essential health service package: an explication of the process and methods used. Health Syst Reform. 2020;6(1):e1829313. doi:1080/23288604.2020.1829313
World Health Organization (WHO). The UHC Compendium: Health Interventions for Universal Health Coverage. WHO; 2021.
Mattingly TJ 2nd, Anderson GF, Levy JF. Comparison of price index methods and drug price inflation estimates for hepatitis C virus medications. JAMA Health Forum. 2023;4(6):e231317. doi:1001/jamahealthforum.2023.1317
Sachs J. Macroeconomics and Health: Investing in Health for Economic Development: Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.
Singh D, Prinja S, Bahuguna P, et al. Cost of scaling-up comprehensive primary health care in India: implications for universal health coverage. Health Policy Plan. 2021;36(4):407-417. doi:1093/heapol/czaa157
National Academies of Sciences, Engineering, and Medicine. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: National Academies of Sciences, Engineering, and Medicine; 2018.
Zeng W, Halasa YA, Cros M, Akhter H, Nandakumar AK, Shepard DS. Costing essential services package provided by a non-governmental organization network in Bangladesh. Health Policy Plan. 2017;32(10):1375-1385. doi:1093/heapol/czx105