Medical Abortions in the Public Health Sector
WOMEN'S HEALTH RESEARCH UNIT Department of Public Health and Family Medicine University of Cape Town Cost analysis of service provision of medical abortions in the public health sector at primary and secondary level. Objectives: Define a standard protocol for medical abortion at primary and secondary level; 2. Identify and quantify resources and costs required; Determine the average cost at different levels of service delivery utilizing an economic model; and 4. Identify additional costs required for implementation. 1. DEFINE A STANDARD PROTOCOL: Gestation < 56 days Initial visit MIFEPRISTONE Home MISOPROSTOL Unscheduled follow up visits Unscheduled telephone calls Scheduled follow up visit 14 days Minor complaints: No treatment required Complications MVA (3-8%) Transfusion (0.1%) Infection (0.05-0.9%) 2. IDENTIFY AND QUANTIFY COSTS: - Questionnaire to key informants - Quantify costs:
Diagnostic tests / Investigations / Laboratory costs
*USD/ZAR exchange rate = 11.45492 (18/01/02)
a. Drugs - mifepristone*, other drugs TOTAL COST SPECIFIED DRUG TOTAL DOSE INITIAL VISIT: Mifepristone Option 1: Misoprostol Paracetamol COMPLICATIONS: b. Diagnostic tests / Investigations / Laboratory costs TOTAL COST INVESTIGATION INITIAL VISIT: Pregnancy test Finger-prick Hb (cost of personnel included in HR Rhesus blood grouping RPR (qualitative) COMPLICATIONS: c. Ultrasound PRIMARY LEVEL SECONDARY LEVEL TOTAL NUMBER OF SCANS PREDICTED FOR ANNUAL REPLACEMENT R29 415.88 R 29 415.88 ANNUAL RECURRENT COSTS Consumables: Personnel: COST PER US SCAN d. Human Resources Personnel required (identified by the key informants) Admin staff, PN, EN, MO, Pharmacist, Social Worker
The total personnel cost per management process was calculated using
the contact time per provider and the cost per minute for that provider d. Human Resources cont. TOTAL PERSONNEL COST INITIAL VISIT UNSCHEDULED FOLLOW UP VISIT SCHEDULED FOLLOW UP VISIT COMPLICATIONS Incomplete abortion requiring MVA Infection Blood transfusion e. Overhead costs OVERHEAD COST PER OPD VISIT TOTAL AVERAGE COST OF PROVIDING MEDICAL ABORTION (PN) PRIMARY LEVEL SECONDARY LEVEL
Mifepristone dose 200 mg
Mifepristone dose 600 mg
11% increase when medical abortion (mifepristone 200mg) performed by a doctor at primary level and 8% increase when performed by a doctor at secondary level. There is on average an 84% increase in the total cost of medical abortion when a dosage regimen of 600mg versus 200 mg is used. ULTRASOUND (PN) Increase of total Increase of total cost using cost using Cost U/S /pt mifepristone mifepristone SECONDARY ADDITIONAL COSTS REQUIRED FOR IMPLEMENTATION
Adequate training resources for education of providers
Resources to ensure continued support of providers
Resources for research purposes (including M&E)
Resources relating to the ? provision of ultrasound for early gestational dating Marketing resources to ensure that clients are aware of the method and the early gestational age at which this method may be chosen
Resources for educational purposes at community level (for example, to enable clients to identify early signs of pregnancy)
Resources to ensure that pre-, and post-abortion counseling is provided COST DRIVERS
• The main cost driver is the DOSAGE REGIMEN used
• PERSONNEL performing the procedure
• PRIMARY or SECONDARY level
• Current EXCHANGE RATE
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Building strong condition brands Received (in revised form): 14th May, 2007 Reinhard Angelmar is the Salmon and Rameau Fellow in Healthcare Management and Professor of Marketing at INSEAD, Fontainebleau. An author of many studies on the pharmaceutical industry, he has worked with pharmaceutical companies such as Johnson & Johnson, Lilly, Novartis and Pfi zer. He teaches a course