Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan

Abstract

Background: The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards Universal Health Coverage (UHC) by 2030 by providing an essential package for health services (EPHS). Starting in 2019, the Disease Control Priorities 3 (DCP3) evidence framework was used to guide the development of Pakistan’s EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. Methods: A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. Results: Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1,478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. Conclusion: We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.