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Table 1 Costing methodology

From: Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

Cost category

Estimation method

Medicines – ARV and non-ARV

All medicines (ARV and non-ARV) prescribed during the study period were extracted from the patient medical record. If at the last visit in the study period medicines were prescribed for a period that exceeded the study period then only the amount of those medicines necessary to cover the remaining study period were included. Drug costs were obtained from the 2019 Master Procurement Catalogue (National Department of Health, South Africa) national tender price list for sites that had access to public sector medicines (Pub1, Pub2, Prv1, Prv2) and from the South African Single Exit Price list (Medicine Price Register, www.mpr.org.za) for the site (Prv3) which procured privately.

Laboratory tests

All laboratory tests (HIV related and other) conducted during the study period were extracted from the patient medical record. Viral loads conducted after the study period (12–15 months) were used to assign outcome but not included as part of the resource usage. Laboratory costs for sites with access to state laboratory tests (Pub1, Pub2, Prv1, Prv2) were obtained from the National Health Laboratory Services State Price List (2017) inflated to 2019 prices using the annual inflation as reported by the IMF for South Africa [13]. We used laboratory costs from the private sector laboratory that serviced the site (Prv3) that did not have access to state laboratory costs.

Staff - clinical

All clinical visits to the site during the study period were extracted from the patient medical record. The salary costs of all staff providing clinical care were obtained from the site financial records or estimated based on the national salary scales published by the Department of Public Service and Administration for 2019 [14]. The cost per visit was estimated by taking the total annual salary cost for clinical staff and dividing it by the total annual patient visits. Each patient was then allocated a staff clinical cost based on the number of visits they made.

Staff – non-clinical

The salary costs of all staff who were not providing clinical care (i.e., administration, reception, social services) were obtained from the site financial records or estimated based on the national salary scales [14]. The cost per visit was estimated by taking the total annual salary cost for these staff members and dividing it by the total annual patients’ visits (i.e., visits for any reason). Each patient was then allocated a staff non-clinical cost based on the number of visits they made.

Fixed (Space, equipment, utilities, supplies)

The total space required to provide care was measured and the cost was estimated based on a market based rental estimate for the area. Equipment for the space was inventoried, valued at 2019 replacement cost and annualized over the estimated lifespan based on standard accounting guidelines. Utilities were estimated based on the size of the space and a standardized utility (i.e., power, water and refuse) estimate per square meter. Annual cost of non-medical supplies was obtained from facilities records and financial statements. The cost per visit was estimated by taking the total annual fixed costs and dividing by the total annual patient visits. Each patient was then allocated a fixed cost based on the number of visits they made.

Fixed fee

We used a fixed fee per patient visit for two of the private models (Prv2 and Prv3). This fee covered the fixed and staff related costs, as well as any network administration or management fees used in the model. Fees are determined based on the number of visits and services offered. Based on the resources utilized by each patient and the fee structure of the model, the fee for each patient was estimated. If government were to expand HIV services in the public sector through these models these would be the associated costs. Costs not covered by the fee such as medicines and laboratory costs are still reported for these models.