Lee cullingworth

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

Source: http://www.icma.md/uploads/file/lee_cullingworth.pdf