Peer Review Report For: Estimating the unit cost of voluntary medical male circumcision using surgical and device methods in integrated health settings in Kenya [version 1; peer review: 2 approved with reservations]

Résumé

Background Successful voluntary medical male circumcision (VMMC) programmes need to integrate various programme elements into health service delivery to optimize resources. We estimated the unit cost for the delivery of VMMC services in integrated health settings designed to provide a package of services, including education, risk reduction counselling, condom promotion, HIV testing and information on the VMMC procedures, in Kenya. Methods An ingredient costing approach was used to estimate the unit cost in 5 health facilities, using surgical and device methods in Homabay and Kisumu counties, western Kenya. Data were collected retrospectively by reviewing financial and asset records in the health facilities located in rural and urban settings, for the period 2017–2018. Results The unit cost of delivering non-complicated VMMC procedures to infants aged 0-60 days was $14.05 (by device), to boys aged 10–14 years was USD $19.35 (range $13.99-$22.54) by surgery, and to adolescent and adults over 14 years was $19.34 (range $13.84-$22.85) by surgery and was $20.5 by device. The overall unit cost for delivering VMMC services with moderate and mild complications to infants was $17.88 and $18.78 respectively; to adolescents aged 10–14 years across all the sites were $23.33 and $22.18, respectively and to adolescents and adults above 14 years across all the sites were $25.31 and $22.31 respectively for surgical method and were $23.32 and $23.25 respectively for device method. The highest cost heads were related to direct cost heads related to direct staff cost, consumable drugs and supplies and non consumable supplies. Conclusions The average cost per VMMC using an integrated service model was much lower compared to results from previous costing studies which used a stand-alone delivery model. The provision of VMMC services within an integrated setting can be cost-saving.

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