Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

• Published in: BMC health services research 2014-07, Vol.14 (1), p.316-316, Article 316
• Main Authors: Kempers, Jari, Ketting, Evert, Lesco, Galina
• Format: Article
• Language: English
• Subjects: Abortion; Adolescent; Adolescent Health Services - economics; Adolescent Health Services - standards; Age groups; Birth control; Catchment Area (Health); Cost analysis; Cost-Benefit Analysis; Costs and Cost Analysis; Counseling; Economic aspects; Female; Health care policy; Health facilities; Health services; Health Services Research; HIV; Human immunodeficiency virus; Humans; Male; Medical care, Cost of; Medical supplies; Moldova; Office supplies; Pregnancy; Quality; Quality of Health Care; Reproductive health; Reproductive Health Services - economics; Reproductive Health Services - standards; Retrospective Studies; Time use; Towns; Wages & salaries; Working hours
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-14-316

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies.