IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v25y2016is1p53-66.html
   My bibliography  Save this article

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

Author

Listed:
  • Lucy Cunnama
  • Edina Sinanovic
  • Lebogang Ramma
  • Nicola Foster
  • Leigh Berrie
  • Wendy Stevens
  • Sebaka Molapo
  • Puleng Marokane
  • Kerrigan McCarthy
  • Gavin Churchyard
  • Anna Vassall

Abstract

Purpose 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. Materials and methods We estimate costs, by applying two distinct approaches of bottom‐up and top‐down costing, together with an assessment of processes and capacity. Results 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. Conclusion 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, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.

Suggested Citation

  • Lucy Cunnama & Edina Sinanovic & Lebogang Ramma & Nicola Foster & Leigh Berrie & Wendy Stevens & Sebaka Molapo & Puleng Marokane & Kerrigan McCarthy & Gavin Churchyard & Anna Vassall, 2016. "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, John Wiley & Sons, Ltd., vol. 25(S1), pages 53-66, February.
  • Handle: RePEc:wly:hlthec:v:25:y:2016:i:s1:p:53-66
    DOI: 10.1002/hec.3295
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.3295
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.3295?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Michael K. Chapko & Chuan‐Fen Liu & Mark Perkins & Yu‐Fang Li & John C. Fortney & Matthew L. Maciejewski, 2009. "Equivalence of two healthcare costing methods: bottom‐up and top‐down," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1188-1201, October.
    2. Sarah Wordsworth & Anne Ludbrook & Fergus Caskey & Alison Macleod, 2005. "Collecting unit cost data in multicentre studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 38-44, March.
    3. Grégoire Mercier & Gérald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," Post-Print hal-01829947, HAL.
    4. Gregoire Mercier & Gerald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Joanna Jędrzejczak & Beata Majkowska-Zwolińska & Anna Chudzicka-Bator & Iwona Żerda & Magdalena Władysiuk & Brian Godman, 2021. "Economic and social cost of epilepsy in Poland: 5-year analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 485-497, April.
    2. Catherine Pitt & Catherine Goodman & Kara Hanson, 2016. "Economic Evaluation in Global Perspective: A Bibliometric Analysis of the Recent Literature," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 9-28, February.
    3. Sayem Ahmed & Md Zahid Hasan & Nausad Ali & Mohammad Wahid Ahmed & Emranul Haq & Sadia Shabnam & Morseda Chowdhury & Breda Gahan & Christine Bousquet & Jahangir A M Khan & Ziaul Islam, 2021. "Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-31, November.
    4. Lelisa Fekadu Assebe & Wondesen Nigatu Belete & Senait Alemayehu & Elias Asfaw & Kora Tushune Godana & Yibeltal Kiflie Alemayehu & Alula M Teklu & Amanuel Yigezu, 2021. "Economic evaluation of Health Extension Program packages in Ethiopia," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-16, February.
    5. Zhuoyu Wang & Nandini Dendukuri & Madhukar Pai & Lawrence Joseph, 2017. "Taking Costs and Diagnostic Test Accuracy into Account When Designing Prevalence Studies: An Application to Childhood Tuberculosis Prevalence," Medical Decision Making, , vol. 37(8), pages 922-929, November.
    6. Catherine Pitt & Anna Vassall & Yot Teerawattananon & Ulla K. Griffiths & Lorna Guinness & Damian Walker & Nicola Foster & Kara Hanson, 2016. "Foreword: Health Economic Evaluations in Low‐ and Middle‐income Countries: Methodological Issues and Challenges for Priority Setting," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 1-5, February.
    7. Ulla Kou Griffiths & Rosa Legood & Catherine Pitt, 2016. "Comparison of Economic Evaluation Methods Across Low‐income, Middle‐income and High‐income Countries: What are the Differences and Why?," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 29-41, February.
    8. Nicola Foster & Lucy Cunnama & Kerrigan McCarthy & Lebogang Ramma & Mariana Siapka & Edina Sinanovic & Gavin Churchyard & Katherine Fielding & Alison D Grant & Susan Cleary, 2021. "Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 16(5), pages 1-21, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Sandra Sülz & Holger Wagenaar & Joris van de Klundert, 2021. "Have Dutch Hospitals Saved Lives and Reduced Costs? A longitudinal patient‐level analysis over the years 2013–2017," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2399-2408, September.
    2. Adam D M Briggs & Peter Scarborough & Jane Wolstenholme, 2018. "Estimating comparable English healthcare costs for multiple diseases and unrelated future costs for use in health and public health economic modelling," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-14, May.
    3. Eva Glaeser & Bart Jacobs & Bernd Appelt & Elias Engelking & Ir Por & Kunthea Yem & Steffen Flessa, 2020. "Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia—A Prerequisite for Efficient and Fair Comprehensive Obstetric Care," IJERPH, MDPI, vol. 17(21), pages 1-15, November.
    4. Raulinajtys-Grzybek, Monika, 2014. "Cost accounting models used for price-setting of health services: An international review," Health Policy, Elsevier, vol. 118(3), pages 341-353.
    5. Zuzana Špacírová & David Epstein & Leticia García-Mochón & Joan Rovira & Antonio Olry de Labry Lima & Jaime Espín, 2020. "A general framework for classifying costing methods for economic evaluation of health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 529-542, June.
    6. Grégoire Mercier & Gérald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," Post-Print hal-01829947, HAL.
    7. Xiao Xu & Christina M. Lazar & Jennifer Prah Ruger, 2021. "Micro-costing in health and medicine: a critical appraisal," Health Economics Review, Springer, vol. 11(1), pages 1-8, December.
    8. Malgorzata Cyganska & Piotr Cyganski & Chris Pyke, 2019. "Development of clinical value unit method for calculating patient costs," Health Economics, John Wiley & Sons, Ltd., vol. 28(8), pages 971-983, August.
    9. Bugge, Christoffer & Sæther, Erik Magnus & Brustugun, Odd Terje & Kristiansen, Ivar Sønbø, 2021. "Societal cost of cancer in Norway –Results of taking a broader cost perspective," Health Policy, Elsevier, vol. 125(8), pages 1100-1107.
    10. Shankar Prinja & Akashdeep Singh Chauhan & Pankaj Bahuguna & Sakhtivel Selvaraj & V. R. Muraleedharan & Thiagarajan Sundararaman, 2020. "Cost of Delivering Secondary Healthcare Through the Public Sector in India," PharmacoEconomics - Open, Springer, vol. 4(2), pages 249-261, June.
    11. Tina Olsson, 2011. "Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(5), pages 445-453, October.
    12. Vogl, Matthias, 2013. "Improving patient-level costing in the English and the German ‘DRG’ system," Health Policy, Elsevier, vol. 109(3), pages 290-300.
    13. Akashdeep Singh Chauhan & Shankar Prinja & Sushmita Ghoshal & Roshan Verma & Arun S Oinam, 2018. "Cost of treatment for head and neck cancer in India," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    14. Siti Norain Azahar & Saperi Sulong & Wan Asyraf Wan Zaidi & Norliza Muhammad & Yusof Kamisah & Norliana Masbah, 2022. "Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(3), pages 1-17, January.
    15. Cohen, Deborah & Manuel, Douglas G. & Tugwell, Peter & Sanmartin, Claudia & Ramsay, Tim, 2014. "Direct healthcare costs of acute myocardial infarction in Canada’s elderly across the continuum of care," The Journal of the Economics of Ageing, Elsevier, vol. 3(C), pages 44-49.
    16. Kathleen Carey & Theodore Stefos, 2011. "Measuring the cost of hospital adverse patient safety events," Health Economics, John Wiley & Sons, Ltd., vol. 20(12), pages 1417-1430, December.
    17. Indrani Gupta & Mayur Trivedi & Vishal Jani & Kanksha Barman & Avantika Ranjan & Manas Sharma, 2021. "Costing Of Health And Wellness Centre A Case Study Of Gujarat," IEG Working Papers 415, Institute of Economic Growth.
    18. Tarricone, Rosanna, 2006. "Cost-of-illness analysis: What room in health economics?," Health Policy, Elsevier, vol. 77(1), pages 51-63, June.
    19. Abdelbaste Hrifach & Coralie Brault & Sandrine Couray-Targe & Lionel Badet & Pascale Guerre & Christell Ganne & Hassan Serrier & Vanessa Labeye & Pierre Farge & Cyrille Colin, 2016. "Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    20. Šárka Papadaki & Boris Popesko, 2016. "Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach," Global Journal of Health Science, Canadian Center of Science and Education, vol. 8(6), pages 234-234, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:25:y:2016:i:s1:p:53-66. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.