Wednesday, October 26, 2011: 10:30 AM
Columbus Hall C-F (Hyatt Regency Chicago)
(ESP) Applied Health Economics, Services, and Policy Research

Jared A. Leff, MS1, Ashley A. Eggman, MS1, Louise F. Haynes, MSW2, Beverly E. Holmes, MSW3, Jeffrey E. Korte, PhD4, Lauren Gooden, MPH5, Daniel J. Feaster, PhD5, Lisa R. Metsch, PhD5, Grant N. Colfax, PhD6 and Bruce R. Schackman, PhD1, (1)Weill Cornell Medical College, New York, NY, (2)Medical University of South Carolina, Charleston, SC, (3)Lexington Richland Alcohol and Drug Abuse Council, Columbia, SC, (4)Medical University of South Carolina, Columbia, SC, (5)Miller School of Medicine, Miami, FL, (6)San Francisco Department of Public Health, San Francisco, CA

Purpose: Micro-costing is often conducted to determine incremental costs of an intervention for cost-effectiveness analysis, but may not be consistent with budgetary costs used for implementation. We describe these differences using a case study of implementation of rapid HIV testing and counseling in a substance abuse treatment program following a clinical trial.

Method: During the clinical trial, we used micro-costing methods to determine the cost of HIV testing in substance abuse treatment programs to conduct a cost-effectiveness analysis. Time and materials were from study records (including start and stop times for time conducting on-site testing and counseling) and site interviews; labor costs assume full capacity and were valued at local labor rates; and overhead was calculated from site financial records and applied as a percentage of labor costs. Costs include counselor and other labor, rapid HIV test and materials, supervision, quality control, and overhead. After the trial, one site implemented on-site rapid HIV testing with risk-reduction counseling in its detoxification program for 30 weeks. We compared projected costs in 2009 US dollars of implementation at this site based on micro-costing to budgetary costs reported by the site.

Result: The site administered 184 rapid HIV tests during the implementation period. Projected total costs for this period using micro-costing were $13,900 versus $20,300 budgetary costs. Labor costs based on micro-costing were $5,500 (245 hours) versus $16,700 (784 hours) budgeted for staff assigned to implementation. Overhead based on micro-costing was $5,500 versus $3,500 budgeted. Costs of tests and counseling supplies were estimated at $2,200 using micro-costing, whereas in the implementation the tests and supplies were provided from public health sources without cost to the site. Quality assurance costs using micro-costing were $700 but these costs were not separately budgeted in the implementation.

Conclusion: Cost estimates developed for cost-effectiveness analysis using micro-costing should not be indiscriminately applied when planning for implementation. Micro-costing may underestimate some costs (e.g. by assuming full capacity labor utilization) and overestimate others (e.g. by not considering donated materials and services). Micro-costing, however, may also identify cost categories not fully covered by implementation budgets (e.g. overhead and quality assurance).