Table 1. Stepwise validation models and data updates applied in the revision of 2007 World Health Organization (WHO) global estimates for child survival interventions, 2010–2015.
| Modela and description | Reference year for price data | Country-validated assumptions | Reference year for population, incidence and intervention coverage data | Inputs updated | Expected effect on overall costs, all else being the same | Finding |
|---|---|---|---|---|---|---|
| Original 2007 WHO | ||||||
| Original price tag | 2004 | No | Population, 2002; incidence and coverage, 2004 |
_ | _ | _ |
| Validation (V) and update (U) analysis (n = 26) | ||||||
| Model V: original price tag estimates updated with country inputs | 2004 | Yes | Population, 2002; incidence and coverage, 2004 |
Country inputs | Unknown (depending on higher/lower country validation of ingredients) | Costs increased by 53% from original |
| Model U1: as per model V, with population updates | 2004 | Yes | Population, 2008 | Population, update from 2002 to 2008 projections (medium variant) | Expect higher costs, as population estimates have increased on average since the 2002 projections for the 75 countries | Costs for V2 decreased by 3% (vs V) |
| Model U2: as per model V, with incidence updates | 2004 | Yes | Incidence15 of severe malnutrition | Incidence, new formulas available for estimating incidence from prevalence | Expect higher costs, as incidence estimates will increase | Costs increased 15% (vs V) |
| Model U3: As per model V, with coverage updates | 2004 | Yes | Coverage, Countdown 2008b | Intervention coverage | Expect lower additional costs (than original) because current coverage has most likely increased | Coverage resulted in 5% higher costs (vs V) but effect not significant when combined with demographic data (U4) |
| Model U4: V and U1–U3 combined (population, incidence and coverage updates) | 2004 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | Examine combined effect of updating population, incidence and coverage | Unknown | _ |
| Sensitivity (S) analysis (n = 26) | ||||||
| Model S1: Model U4 rerun with alternative scale-up strategy (linear) | 2004 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | Linear scale-up | Unknown | Costs decreased slightly due to cost drivers in the sample, e.g. China, Egypt and India, now with a slower scale-up trajectory than in the original analysis |
| Model S2: Model U4 rerun with alternative population projection, high variant | 2004 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | Population, based on UN 2008 projections, high variant | Expect higher additional costs | Overall costs increased by 2% (vs U4); patient costs increased by 4% |
| Model S3: Model U4 rerun with alternative population projection, low variant | 2004 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | Population, based on UN 2008 projections, low variant | Expect lower additional costs | Overall costs decreased by 3% (vs U4); patient costs decreased by 6% |
| Updating (U) analysis of the global price tag | ||||||
| Model U5 (n = 26): Model U4 rerun with updated 2005 WHO-CHOICE prices | 2005 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | WHO-CHOICE prices | Expect higher costs since WHO-CHOICE price update gives higher price estimates (due to changes in technology mix over time) | Overall costs increased by 16% (vs U4) |
| Extrapolation | ||||||
| To 75 countries: results from Model U5 extrapolated | 2005 | Yes | Population, 2008; incidence15 and coverage, Countdown 2008b | No additional changes in assumptions: extrapolation from 26 to 75 countries | _ | _ |
| Combination | ||||||
| Combinationc: estimates combined with costs for immunization, malaria and PMTCT of HIV | 2005 | NA | NA | Costs taken from recent publications on HIV/AIDS, malaria and immunization | _ | _ |
AIDS, acquired immunodeficiency syndrome; CAH, Department of Child and Adolescent Health and Development (WHO); HIV, human immunodeficiency virus; NA, not applicable; PMTCT, prevention of mother-to-child transmission; UN, United Nations.
a The CAH model includes patient-level intervention cost components: breastfeeding counselling, improvement of complementary feeding, severe malnutrition management, pneumonia management, diarrhoea management, antibiotic treatment for dysentery, measles complications, community-based case management, neonatal infections, vitamin A supplementation and regular deworming. In addition, it includes the following programme-level cost components: community health workers, supervision, training, monitoring and evaluation; information, education and communication; advocacy; laws, policy and regulation; infrastructure; technical assistance; general management.
b Countdown coverage data were only available for three interventions (management of diarrhoea, management of pneumonia and vitamin A supplementation) and for 23 of the 26 selected countries.
c Refers to a combination with other models that include immunization costs; general management and infrastructure for immunization; PMTCT of HIV programmes; general management of PMTCT programmes; costs of malaria interventions in children under five and general management of such malaria programmes.