Table A1.

iDSI Reference Case and VAWG guidelines.

iDSI Statements of Principle (Adapted with permission from: https://www.idsihealth.org/resources/summary-table/)	VAWG Guidelines
1. Clear and transparent communication to enable the decision maker(s) to interpret methods and results (also in GHCC 1, 2, and 17).	Adherence to these guidelines is recommended, and reasons for deviation should be provided.
2. Comparator(s) to accurately reflect the decision problem (see also GHCC 1).	These guidelines describe cost data collection and analysis methods for the purpose of economic evaluation of VAWG prevention interventions, and have wider applicability to behavioral change and development interventions. A PICO statement is used to describe the intervention. This identifies all key elements of the decision problem and excludes any non-pertinent elements (also see “comparator” section)
3. Consider all available evidence relevant to the decision problem.	Include all evidence from the literature that may be relevant to the decision problem. Where this information is not available, direct communication with policy makers may provide the required information.
4. Health outcome measure is (a) appropriate to the decision problem, capturing positive and negative effects on length and quality of life, and (b) generalizable across disease states (see also GHCC 4).	Intervention outcomes should encompass (a) an effect measure in natural units—For example, years free of VAWG; (b) a health outcome measure, namely, DALYs; (c) psychological and socioeconomic measures capturing outcomes likely to be affected by the intervention; and (d) measures of well-being, to capture overall well-being impact and as a proxy for the utility individuals derived from the intervention.
5. All differences in the expected resource use and costs of delivery between intervention and comparator should be incorporated into the evaluation.	Studies should implement a bottom-up approach based on micro-costing for direct costs. Deviation from this recommendation is acceptable for management costs, which could be computed using a top-down approach. Research costs are recorded and reported but excluded from cost-effectiveness estimates. Data are to be collected with a view to informing scalability analyses.
6. Time horizon should be of sufficient length to capture all costs and effects relevant to the decision problem. An appropriate discount rate should be used to discount cost and effects to present values (see also GHCC 5).	The time horizon covers intervention adaptation and setup (i.e., training of local staff and community entry), in addition to implementation. It also includes intervention development where interventions are new and have never been tested for cost-effectiveness. Costs should be reported separately for each of these phases. Total development costs are to be reported separately only and not included in the cost-effectiveness estimates. A 3% discount rate is to be used to capture time preferences effectiveness.
7 . Non-health effects and costs that do not accrue to the health budget should be identified where relevant to the decision problem. All costs and effects should be disaggregated, either by sector of the economy or by whom they are incurred (see also GHCC 4).	Most of the costs incurred to develop and deliver VAWG prevention interventions fall under non-health budgets. We recommend quantifying and analyzing all these costs. The micro-costing approach allows for disaggregation of costs by contributing sector, where relevant.
8. The cost and effects of the intervention on sub-populations should be explored and implications characterized (see also GHCC 5, which also includes variation by site/organization).	We recommend analysts collect cost data with sufficient variation in geography, size, and platform type to analyze how these key cost drivers may affect overall intervention cost. The cost-effectiveness analysis should report on pre-specified sub-populations for trials (i.e., sub-populations listed in the trial protocol) and on sub-populations likely to differ substantially from the average in terms of costs and/or cost-effectiveness (also see iDSI Principle 8).
9. Uncertainty should be appropriately characterized (see also GHCC 16).	Model and parameter uncertainty is to be addressed with uni- and multivariate sensitivity analysis. Monte Carlo simulations are to be used to explore precision of the estimates. Intervention sustainability is to be investigated based on changes in VAWG impact post-exposure to the intervention, where the data are available.
10. The impact of implementing the intervention on health budget and on other constraints should be clearly and separately identified.	Where interventions are successful and likely to be funded, budget impact analysis will be conducted for the national or local government. Where clients or target populations incur costs to access services, we also recommend a societal perspective. A societal perspective should also include productivity losses due to VAWG and may include costs to non-health sectors such as criminal justice or social services.
11. An economic evaluation should explore the equity implications of implementing the intervention.	Analysts should explore potential inequalities in access and ability to benefit connected to baseline health or socioeconomic characteristics, or levels of VAWG exposure via, for example, subgroup analyses.

Note. This table contains a summary of our guidance for conducting economic evaluations of VAWG prevention and women’s empowerment interventions in low- and middle-income countries. The reader is encouraged to refer to the main body of the article for in-depth explanations. Our accompanying costing guidelines (at https://bit.ly/2vKaGZZ), the iDSI Reference Case and the GHCC Reference Case websites offer further insights into the concepts referred in the table. iDSI = International Decision Support Initiative; VAWG = violence against women and girls; GHCC = Global Health Costing Consortium; PICO = Population Intervention Comparator Outcome; DALYs = disability-adjusted life years.