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Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India
BACKGROUND: Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not ava...
Autores principales: | , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2005
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291366/ https://www.ncbi.nlm.nih.gov/pubmed/16271151 http://dx.doi.org/10.1186/1472-6963-5-69 |
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author | Dandona, Lalit Sisodia, Pratap Prasad, TLN Marseille, Elliot Chalapathi Rao, M Kumar, A Anod Kumar, SG Prem Ramesh, YK Over, Mead Someshwar, M Kahn, James G |
author_facet | Dandona, Lalit Sisodia, Pratap Prasad, TLN Marseille, Elliot Chalapathi Rao, M Kumar, A Anod Kumar, SG Prem Ramesh, YK Over, Mead Someshwar, M Kahn, James G |
author_sort | Dandona, Lalit |
collection | PubMed |
description | BACKGROUND: Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services. METHODS: Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated. RESULTS: 18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$ 4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R(2 )= 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision. CONCLUSION: There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources. |
format | Text |
id | pubmed-1291366 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2005 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-12913662005-11-26 Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India Dandona, Lalit Sisodia, Pratap Prasad, TLN Marseille, Elliot Chalapathi Rao, M Kumar, A Anod Kumar, SG Prem Ramesh, YK Over, Mead Someshwar, M Kahn, James G BMC Health Serv Res Research Article BACKGROUND: Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services. METHODS: Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated. RESULTS: 18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$ 4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R(2 )= 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision. CONCLUSION: There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources. BioMed Central 2005-11-05 /pmc/articles/PMC1291366/ /pubmed/16271151 http://dx.doi.org/10.1186/1472-6963-5-69 Text en Copyright © 2005 Dandona et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Dandona, Lalit Sisodia, Pratap Prasad, TLN Marseille, Elliot Chalapathi Rao, M Kumar, A Anod Kumar, SG Prem Ramesh, YK Over, Mead Someshwar, M Kahn, James G Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title | Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title_full | Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title_fullStr | Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title_full_unstemmed | Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title_short | Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India |
title_sort | cost and efficiency of public sector sexually transmitted infection clinics in andhra pradesh, india |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291366/ https://www.ncbi.nlm.nih.gov/pubmed/16271151 http://dx.doi.org/10.1186/1472-6963-5-69 |
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