title: Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology.
abstract: BACKGROUND
  Disease-specific costing studies can be used as input into cost-effectiveness analyses and provide important information for efficient resource allocation. However, limited data availability and limited expertise constrain such studies in low- and middle-income countries (LMICs).
  
  
  OBJECTIVE
  To describe a step-by-step guideline for conducting disease-specific costing studies in LMICs where data availability is limited and to illustrate how the guideline was applied in a costing study of cardiovascular disease prevention care in rural Nigeria.
  
  
  METHODS
  The step-by-step guideline provides practical recommendations on methods and data requirements for six sequential steps: 1) definition of the study perspective, 2) characterization of the unit of analysis, 3) identification of cost items, 4) measurement of cost items, 5) valuation of cost items, and 6) uncertainty analyses.Please provide the significance of asterisk given in table body.
  
  
  RESULTS
  We discuss the necessary tradeoffs between the accuracy of estimates and data availability constraints at each step and illustrate how a mixed methodology of accurate bottom-up micro-costing and more feasible approaches can be used to make optimal use of all available data. An illustrative example from Nigeria is provided.
  
  
  CONCLUSIONS
  An innovative, user-friendly guideline for disease-specific costing in LMICs is presented, using a mixed methodology to account for limited data availability. The illustrative example showed that the step-by-step guideline can be used by healthcare professionals in LMICs to conduct feasible and accurate disease-specific cost analyses.
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands; m.hendriks@aighd.org.
authors.forename: Marleen E
authors.initials: ME
authors.lastname: Hendriks
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Piyali
authors.initials: P
authors.lastname: Kundu
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Boers
authors.affiliation: Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Oladimeji A
authors.initials: OA
authors.lastname: Bolarinwa
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Te Pas
authors.affiliation: Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Tanimola M
authors.initials: TM
authors.lastname: Akande
authors.affiliation: Ogo Oluwa Hospital, Bacita, Nigeria.
authors.forename: Kayode
authors.initials: K
authors.lastname: Agbede
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Gabriella B
authors.initials: GB
authors.lastname: Gomez
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: William K
authors.initials: WK
authors.lastname: Redekop
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Constance
authors.initials: C
authors.lastname: Schultsz
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Siok
authors.initials: S
authors.lastname: Swan Tan
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D004194:Disease / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009549:Nigeria; D035501:Uncertainty
keywords: cost of illness; developing countries; economic evaluation; global health; healthcare costs; methodology; micro-costing; sub-Saharan Africa