How much does a verbal autopsy based mortality surveillance system cost in rural India?

OBJECTIVE: This paper aims to determine the cost of establishing and sustaining a verbal-autopsy based mortality surveillance system in rural India. MATERIALS AND METHODS: Deaths occurring in 45 villages (population 185,629) were documented over a 4-year period from 2003-2007 by 45 non-physician healthcare workers (NPHWs) trained in data collection using a verbal autopsy tool. Causes of death were assigned by 2 physicians for the first year and by one physician for the subsequent years. Costs were calculated for training of interviewers and physicians, data collection, verbal autopsy analysis, project management and infrastructure. Costs were divided by the number of deaths and the population covered in the year. RESULTS: Verbal-autopsies were completed for 96.7% (5786) of all deaths (5895) recorded. The annual cost in year 1 was INR 1,133,491 (USD 24,943) and the total cost per death was INR 757 (USD 16.66). These costs included training of NPHWs and physician reviewers Rs 67,025 (USD 1474), data collection INR 248,400 (USD 5466), dual physician review for cause of death assignment INR 375,000 (USD 8252), and project management INR 341,724 (USD 7520). The average annual cost to run the system each year was INR 822,717 (USD18104) and the cost per death was INR 549 (USD 12) for the next 3 years. Costs were reduced by using single physician review and shortened re-training sessions. The annual cost of running a surveillance system was INR 900,410 (USD 19814). DISCUSSION: This study provides detailed empirical evidence of the costs involved in running a mortality surveillance site using verbal-autopsy.