OPTIMIZING RESOURCE ALLOCATION FOR SUSTAINABLE HIV TREATMENT: A TDABC ANALYSIS OF PROVIDER COSTS FOR ART IN ZIMBABWE
Author(s)
Juliet G. Nyamasve, MHEF1, Carren Pindiriri, PhD1, Alex Ingwani, MPH2, Tonderai Mapako, PhD3, Joconiah Chirenda, PhD1;
1University of Zimbabwe, Harare, Zimbabwe, 2Ministry of Health and Child Care, Harare, Zimbabwe, 3National Blood Service Zimbabwe, Harare, Zimbabwe
1University of Zimbabwe, Harare, Zimbabwe, 2Ministry of Health and Child Care, Harare, Zimbabwe, 3National Blood Service Zimbabwe, Harare, Zimbabwe
OBJECTIVES: This study using Time-Driven Activity-Based Costing (TDABC) to define the essential resource envelope for antiretroviral therapy (ART) and identify specific, actionable opportunities for efficiency gains to safeguard the national program.
METHODS: A TDABC micro-costing analysis was conducted across eleven facilities representing all four levels of Zimbabwe's healthcare system. Standardized data collection captured over 2,500 provider-client interactions. Process maps of the ART patient pathway were developed with national experts to document the standard of care. Data on personnel time, space, equipment, medicines, and laboratory use were integrated to calculate precise, activity-bsed costs per client, which were validated by national stakeholders.
RESULTS: In 2022, the total national provider cost for ART for 1.2 million clients was $168.66 million. Based on current treatment success, annual financial requirement is projected to rise to $192.44 million by 2026. The analysis reveals the detailed unit cost structure essential for budget with the cost to initiate an adult ($57.05) lower than paediatric ($62.70). First year treatment costs were higher ($252.78 per client) in the first year compared to subsequent years, at $138.93 for first line, and $174.93 for second line per client.Laboratory services ($30.72) contributed more to than medicine costs ($27.98) in adult maintenance pathway. Primary level facilities, bearing three quarters of the patient volume, are the linchpin of an efficient system.
CONCLUSIONS: Funding withdrawal contributed to an annual gap of more than $50 million. There is urgent need for robust economic evidence to guide resource allocation. This analysis provides a detailed budget impact assessment of ART in Zimbabwe., quantifying true provider costs and identifying efficiency levers. To sustain ART to 2030, policymakers must improve domestic resource mobilization, strengthen decentralization to cost-effective primary care, and design laboratory models that reduce costs without compromising treatment quality
METHODS: A TDABC micro-costing analysis was conducted across eleven facilities representing all four levels of Zimbabwe's healthcare system. Standardized data collection captured over 2,500 provider-client interactions. Process maps of the ART patient pathway were developed with national experts to document the standard of care. Data on personnel time, space, equipment, medicines, and laboratory use were integrated to calculate precise, activity-bsed costs per client, which were validated by national stakeholders.
RESULTS: In 2022, the total national provider cost for ART for 1.2 million clients was $168.66 million. Based on current treatment success, annual financial requirement is projected to rise to $192.44 million by 2026. The analysis reveals the detailed unit cost structure essential for budget with the cost to initiate an adult ($57.05) lower than paediatric ($62.70). First year treatment costs were higher ($252.78 per client) in the first year compared to subsequent years, at $138.93 for first line, and $174.93 for second line per client.Laboratory services ($30.72) contributed more to than medicine costs ($27.98) in adult maintenance pathway. Primary level facilities, bearing three quarters of the patient volume, are the linchpin of an efficient system.
CONCLUSIONS: Funding withdrawal contributed to an annual gap of more than $50 million. There is urgent need for robust economic evidence to guide resource allocation. This analysis provides a detailed budget impact assessment of ART in Zimbabwe., quantifying true provider costs and identifying efficiency levers. To sustain ART to 2030, policymakers must improve domestic resource mobilization, strengthen decentralization to cost-effective primary care, and design laboratory models that reduce costs without compromising treatment quality
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE20
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)