Continuous Trade-­‐Offs: Developing a Mixed Costing Methodology fot CVD Prevention Care in a Low Resource Setting

Summary There is a lack of disease-­‐specific costing analysis in low-­‐ and middle-­‐income countries, despite the need for such data for efficient allocation of scarce resources. The main challenges to costing include poor financial and clinical data systems and lack of time and resources to carry out comprehensive patient-­‐level analysis. This study develops the optimal methodology for guideline-­‐based cardiovascular disease prevention care in a primacy healthcare center in rural Nigeria. Clinical pathways were used to identify the cost items, which were then valued using a combination of bottom-­‐up micro-­‐costing with top-­‐down and gross-­‐costing approaches. The resulting mixed methodology showed that bottom-­‐up micro-­‐costing could be used for several cost items including personnel, consumables, and medical equipment based on available cost and patient utilization data. More feasible approaches were needed for drugs and non-­‐medical equipment. The methodology was applied to hospital data to give an illustration of cost estimates derived from the methodology. The study concludes that a mixed methodology allows flexibility in data sources and gives patient-­‐level cost estimates relevant for local decision-­‐making. Using this approach can provide a valuable tool in assessing disease-­‐ specific costs for LMIC hospital settings where there are various levels of data accuracy.