Cost and Budget Modelling

Cost and Budget Modelling

Many of HE2RO’s projects generate high-quality evidence on the impact and cost of health interventions in the areas of HIV, TB and sexual and reproductive health. Because we focus on new interventions and models of care, often this data is the only available, or the only at such level of detail. Whenever we can, we maximize the usefulness of our study results by translating them into national-level projections of the cost and impact of rolling out these interventions further.

Working directly with policymakers at the national South African Department of Health, Treasury, and other national and international stakeholders, we use HE2RO’s  primary data to parameterize complex mathematical models that allow us to estimate the impact of sets of interventions at the national level in South Africa in the mid- to long-term. We are thus able to provide information that allows policymakers to make decisions about outcomes, costs, affordability and feasibility based on real programme data representing relevant settings and resources.

Beyond this, because all health policy in South Africa is budgeted for and implemented at the level of the nine provinces, we also work with provincial HIV and finance managers to improve financial planning and management of HIV and TB programmes at that level.


  • Modelling the Cost of the National ART Programme under Different Sets of Guidelines: The National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model)

    On request of the South African Department of Health (NDoH), since 2009 HE2RO has used the detailled cost and outcomes data collected in other projects to develop mathematical models projecting the size of the treatment cohort under different scenarios of antiretroviral treatment (ART eligibility as well as the resulting costs). Our budget models, most notably the National ART Cost Model (NACM) and the Treatment as Prevention Cost Model (TasP Cost Model), have contributed to several sets of 
  • Building HIV Financial Planning and Budgeting Capacity at Provincial Level: The FIN-CAP Project

    While treatment guidelines and the overall funding envelope for antiretroviral treatment in South Africa are decided at the level of the national department of health, the implementation of programmes is the responsibility of each of the nine provinces. In the past, implementation was jeopardized by the lack of capacity for financial planning, expenditure tracking and performance monitoring at the level of provincial HIV and finance managers. The FIN-CAP project, implemented by staff from 
  • Analysing the Impact and Cost of Scaling up Xpert MTB/RIF Technology for TB Diagnosis: The National TB Cost Model (NTCM)

    In the South African context, smear microscopy and other conventional TB diagnostic technologies that have been used for decades, are no longer reliable, because many HIV-positive tuberculosis patients are smear-negative, and the long time to diagnosis means that many patients die without having started TB treatment. In December 2010 the GeneXpert System using the Xpert MTB/RIF assay received a strong recommendation from the World Health Organization as the initial test in individuals with HIV 
  • Supporting the South African HIV/TB Investment Case

    Since 2011, UNAIDS and other international organisations have prompted countries to counter the downward trend in international funding for HIV programmes by developing an investment case for their national HIV responses. These cases aim to maximise the impact of programmes on HIV incidence and deaths by correcting any mismatch between the epidemic and the response, identifying how to go to the required scale and maintain it, cutting unnecessary costs and diversions of capacity while generating 


  • The Testing Platform Cost Model

    This cost model provides a simple tool for analysts and decision-makers to determine the cost per test for a testing platform from a provider’s perspective. For many developing countries, the decision to introduce or scale-up certain laboratory tests is influenced by the associated costs and effectiveness. For example, introducing point-of-care (POC) testing, or low- volume testing technologies, into healthcare programmes may improve access, linkage to care and treatment. This tool can assist policy makers in answering questions related to the cost per test for different test technologies, for example CD4, viral load, Gene-Xpert etc., and ultimately improve programme efficiency.

  • The Healthcare Cost and Outcomes Model

    The Healthcare Cost and Outcomes Model (HCOM) provides a simple tool for analysts and decision-makers to determine the cost-effectiveness of a healthcare intervention in which resources are consumed to produce certain healthcare outcomes.

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