{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:05:55Z","timestamp":1791371155498,"version":"4.3.1"},"reference-count":63,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["223120\/Z\/21\/Z"],"award-info":[{"award-number":["223120\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Community Jameel"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Appl Health Econ Health Policy"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1007\/s40258-026-01030-w","type":"journal-article","created":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T02:33:08Z","timestamp":1777775588000},"page":"707-725","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimating System-Wide Healthcare Costs Using a Health System Model: Application to the Thanzi La Onse Model of Malawi"],"prefix":"10.1007","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1268-1769","authenticated-orcid":false,"given":"Sakshi","family":"Mohan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Newton","family":"Chagoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Abraham","family":"Arega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Chalkley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Connolly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Colbourn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Janou\u0161kov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara D.","family":"Mangal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Manthalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Mfutso-Bengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Molaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Nkhoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalit","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingling","family":"She","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktoria","family":"Tafesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pakwanja Desiree","family":"Twea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Revill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy B.","family":"Hallett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"issue":"2","key":"1030_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/BMJGH-2018-001311","volume":"4","author":"S Verguet","year":"2019","unstructured":"Verguet S, et\u00a0al. Health system modelling research: towards a whole-health-system perspective for identifying good value for money investments in health system strengthening. BMJ Glob Health. 2019;4(2):e001311. https:\/\/doi.org\/10.1136\/BMJGH-2018-001311.","journal-title":"BMJ Glob Health"},{"key":"1030_CR2","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/J.SOCSCIMED.2017.09.005","volume":"194","author":"AY Chang","year":"2017","unstructured":"Chang AY, et\u00a0al. Dynamic modeling approaches to characterize the functioning of health systems: a systematic review of the literature. Soc Sci Med. 2017;194:160\u20137. https:\/\/doi.org\/10.1016\/J.SOCSCIMED.2017.09.005.","journal-title":"Soc Sci Med"},{"key":"1030_CR3","unstructured":"Mohan S et\u00a0al. Theory of change framework for economic evaluation using health system models. 2024."},{"issue":"25","key":"1030_CR4","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1002\/hec","volume":"1","author":"A Vassall","year":"2016","unstructured":"Vassall A, et\u00a0al. Incorporating demand and supply constraints into economic evaluations in low-income and middle-income countries. Health Econ. 2016;1(25):95\u2013115. https:\/\/doi.org\/10.1002\/hec.","journal-title":"Health Econ"},{"key":"1030_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00413-3","author":"TB Hallett","year":"2025","unstructured":"Hallett TB, et\u00a0al. Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015\u201319: a modelling study (Thanzi La Onse). Lancet Glob Health. 2025. https:\/\/doi.org\/10.1016\/S2214-109X(24)00413-3. (ISSN: 2214-109X).","journal-title":"Lancet Glob Health"},{"key":"1030_CR6","unstructured":"Government of Malawi. Health Sector Strategic Plan III 2023\u20132030. Tech. Rep. Lilongwe: Ministry of Health, 2023. https:\/\/dms.hiv.health.gov.mw\/dataset\/malawi-health-sector-strategic-plan-iii-hssp-iii. Accessed 9 Dec 2024."},{"issue":"Supplement-1","key":"1030_CR7","doi-asserted-by":"publisher","first-page":"i118","DOI":"10.1093\/HEAPOL\/CZAD102","volume":"39","author":"L Sharma","year":"2024","unstructured":"Sharma L, et\u00a0al. Donor coordination to support universal health coverage in Malawi. Health Policy Plan. 2024;39(Supplement-1):i118\u201324. https:\/\/doi.org\/10.1093\/HEAPOL\/CZAD102.","journal-title":"Health Policy Plan"},{"issue":"1","key":"1030_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12960-024-00949-2","volume":"22","author":"B She","year":"2024","unstructured":"She B, et\u00a0al. Health workforce needs in Malawi: analysis of the Thanzi La Onse integrated epidemiological model of care. Hum Resour Health. 2024;22(1):1\u201315. https:\/\/doi.org\/10.1186\/S12960-024-00949-2.","journal-title":"Hum Resour Health"},{"issue":"6","key":"1030_CR9","doi-asserted-by":"publisher","first-page":"e1027","DOI":"10.1016\/S2214-109X(24)00095-0","volume":"12","author":"S Mohan","year":"2024","unstructured":"Mohan S, et\u00a0al. Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census. Lancet Glob Health. 2024;12(6):e1027\u201337. https:\/\/doi.org\/10.1016\/S2214-109X(24)00095-0.","journal-title":"Lancet Glob Health"},{"key":"1030_CR10","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PCBI.1012462","author":"M Molaro","year":"2024","unstructured":"Molaro M, et\u00a0al. A new approach to Health Benefits Package design: an application of the Thanzi La Onse model in Malawi. PLoS Comput Biol. 2024. https:\/\/doi.org\/10.1371\/JOURNAL.PCBI.1012462.","journal-title":"PLoS Comput Biol"},{"key":"1030_CR11","doi-asserted-by":"publisher","unstructured":"Mohan S. The potential impact of investments in supply chain strengthening (retrospective analysis). 2024. https:\/\/doi.org\/10.15124\/YAO-7B1G-N044.","DOI":"10.15124\/YAO-7B1G-N044"},{"key":"1030_CR12","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.18300209","author":"T Hallett","year":"2026","unstructured":"Hallett T, et\u00a0al. The Thanzi La Onse Model. 2026. https:\/\/doi.org\/10.5281\/zenodo.18300209.","journal-title":"The Thanzi La Onse Model"},{"key":"1030_CR13","unstructured":"Vassal A, et\u00a0al. Reference case for estimating the costs of global health services and interventions. Global Health Cost Consortium (GHCC): Tech. Rep; 2017."},{"key":"1030_CR14","doi-asserted-by":"publisher","DOI":"10.3402\/GHA.V7.23573","author":"ME Hendriks","year":"2014","unstructured":"Hendriks ME, et\u00a0al. Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action. 2014. https:\/\/doi.org\/10.3402\/GHA.V7.23573.","journal-title":"Glob Health Action"},{"issue":"1","key":"1030_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12962-024-00552-1\/TABLES\/3","volume":"22","author":"M Sittimart","year":"2024","unstructured":"Sittimart M, et\u00a0al. An overview of the perspectives used in health economic evaluations. Cost Effect Resour Alloc. 2024;22(1):1\u201313. https:\/\/doi.org\/10.1186\/S12962-024-00552-1\/TABLES\/3.","journal-title":"Cost Effect Resour Alloc"},{"key":"1030_CR16","unstructured":"Creese A, Parker D. Cost analysis in primary health care: A training manual for programme managers. Tech. Rep. Geneva: World Health Organisation, 1994. https:\/\/iris.who.int\/bitstream\/handle\/10665\/40030\/9241544708.pdf?sequence=1&isAllowed=y.. Accessed 28 Nov 2024."},{"key":"1030_CR17","unstructured":"Coin News. Inflation calculator. https:\/\/www.usinflationcalculator.com\/. Accessed 9 Dec 2024."},{"issue":"9","key":"1030_CR18","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1016\/j.jval.2019.03.021","volume":"22","author":"HC Turner","year":"2019","unstructured":"Turner HC, et\u00a0al. Adjusting for inflation and currency changes within health economic studies. Value Health. 2019;22(9):1026\u201332. https:\/\/doi.org\/10.1016\/j.jval.2019.03.021.","journal-title":"Value Health"},{"key":"1030_CR19","unstructured":"The World Bank. World development indicators. (1978). https:\/\/databank.worldbank.org\/databases.aspx?qterm=world+development+indicators. Accessed 9 Dec 2024."},{"key":"1030_CR20","unstructured":"UCL Institute for Global Health. The Thanzi La Onse (TLO) model repository. 2025. https:\/\/github.com\/UCL\/TLOmodel\/tree\/master\/src\/scripts\/costing"},{"key":"1030_CR21","unstructured":"Government of Malawi. Malawi Standard Treatment Guidelines (5th Edition). Tech. Rep. Lilongwe, 2015. https:\/\/extranet.who.int\/ncdccs\/data\/mwi_d1_malawi-standard-treatment-guidelines-essential-medicines-list-2015.pdf. Accessed 1 Dec 2025."},{"key":"1030_CR22","unstructured":"Office of the Inspector General. Audit Report Global Fund Grants in Malawi. Tech. Rep. Geneva: The Global Fund, 2019."},{"issue":"8","key":"1030_CR23","doi-asserted-by":"publisher","first-page":"635","DOI":"10.2165\/10899570-000000000-00000\/FIGURES\/TAB2","volume":"27","author":"DA Hughes","year":"2009","unstructured":"Hughes DA, Tilson L, Drummond M. Estimating drug costs in economic evaluations in Ireland and the UK: an analysis of practice and research recommendations. Pharmacoeconomics. 2009;27(8):635\u201343. https:\/\/doi.org\/10.2165\/10899570-000000000-00000\/FIGURES\/TAB2.","journal-title":"Pharmacoeconomics"},{"key":"1030_CR24","unstructured":"Ministry of Health. Open Logistic Management Information System (OpenLMIS). Tech. Rep. Lilongwe: Government of Malawi; 2018."},{"key":"1030_CR25","unstructured":"Netten A et\u00a0al. A ready reckoner for staff costs in the NHS. Volume II. Methodology. Downloaded publication in Acrobat format. Tech. Rep. 1998. www.ukc.ac.uk\/PSSRU\/. Accessed 18 Nov 2024."},{"key":"1030_CR26","doi-asserted-by":"crossref","unstructured":"Walker D, Kumaranayake L. Introduction: costs over time How to do (or not to do). Allowing for differential timing in cost analyses: discounting and annualization. In. 2002.","DOI":"10.1093\/heapol\/17.1.112"},{"key":"1030_CR27","unstructured":"Government of Malawi. Detailed annex for the health workforce interventions of the Malawi Health Sector Strategic Plan (HSSP III) for 2023\u20132030. Tech. Rep. Lilongwe: Ministry of Health; 2023."},{"key":"1030_CR28","volume-title":"How to plan and budget for your healthcare technology. Ed. by Caroline Temple-Bird","author":"C Temple-Bird","year":"2005","unstructured":"Temple-Bird C, et\u00a0al. How to plan and budget for your healthcare technology. Ed. by Caroline Temple-Bird. Ziken International; 2005."},{"key":"1030_CR29","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2147\/MDER.S401041","volume":"16","author":"ET Geta","year":"2023","unstructured":"Geta ET, Terefa DR, Desisa AE. Efficiency of medical equipment utilization and its associated factors at public referral hospitals in East Wollega Zone, Oromia Regional State, Ethiopia. Med Devices (Auckland NZ). 2023;16:37. https:\/\/doi.org\/10.2147\/MDER.S401041.","journal-title":"Med Devices (Auckland NZ)"},{"key":"1030_CR30","doi-asserted-by":"publisher","unstructured":"Nkhoma D et\u00a0al. Thanzi La Mawa (TLM) datasets: health worker time and motion, patient exit interview and follow-up, and health facility resources, perceptions and quality in Malawi. medRxiv 2024, 2024.11.14.24317330. https:\/\/doi.org\/10.1101\/2024.11.14.24317330.","DOI":"10.1101\/2024.11.14.24317330"},{"key":"1030_CR31","unstructured":"Nkhoma D et\u00a0al. Thanzi La Mawa (TLM) Study datasets. Dec. 2025. https:\/\/github.com\/HEPUMW\/TLM-data-release\/releases\/tag\/tlmdata_v1. Accessed 19 Dec 2025."},{"issue":"1","key":"1030_CR32","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1093\/HEAPOL\/CZZ127","volume":"35","author":"M Haacker","year":"2020","unstructured":"Haacker M, Hallett TB, Atun R. On discount rates for economic evaluations in global health. Health Policy Plan. 2020;35(1):107\u201314. https:\/\/doi.org\/10.1093\/HEAPOL\/CZZ127.","journal-title":"Health Policy Plan"},{"key":"1030_CR33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/HEAPOL\/CZAB104","volume":"00","author":"J Lomas","year":"2021","unstructured":"Lomas J, Claxton K, Ochalek J. Accounting for country- and time-specific values in the economic evaluation of health-related projects relevant to low- and middle-income countries. Health Policy Plan. 2021;00:1\u201310. https:\/\/doi.org\/10.1093\/HEAPOL\/CZAB104.","journal-title":"Health Policy Plan"},{"issue":"11","key":"1030_CR34","doi-asserted-by":"publisher","first-page":"673","DOI":"10.34172\/IJHPM.2020.244","volume":"10","author":"MY Bertram","year":"2021","unstructured":"Bertram MY, et\u00a0al. Methods for the economic evaluation of health care interventions for priority setting in the health system: an update from WHO CHOICE. Int J Health Policy Manag. 2021;10(11):673. https:\/\/doi.org\/10.34172\/IJHPM.2020.244.","journal-title":"Int J Health Policy Manag"},{"issue":"8","key":"1030_CR35","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/J.JVAL.2016.04.015","volume":"19","author":"T Wilkinson","year":"2016","unstructured":"Wilkinson T, et\u00a0al. The international decision support initiative reference case for economic evaluation: an aid to thought. Value in Health. 2016;19(8):921\u20138. https:\/\/doi.org\/10.1016\/J.JVAL.2016.04.015.","journal-title":"Value in Health"},{"key":"1030_CR36","unstructured":"Medecins Sans Frontiers Access Campaign. Antiretroviral prices in 2023. Tech. Rep. 2024. https:\/\/www.msfaccess.org\/antiretroviral-prices-2023. Accessed 9 Dec 2024."},{"key":"1030_CR37","unstructured":"Clinton Health Access Initiative. HIV market report: the state of HIV treatment, testing and prevention in low- and middle-income countries (Issue 10). Tech. Rep. Clinton Health Access Initiative, 2019. https:\/\/clintonhealthaccess.org\/wp-content\/uploads\/2019\/12\/2019-HIV-Market-Report.pdf. Accessed 15 Jan 2025."},{"issue":"4","key":"1030_CR38","doi-asserted-by":"publisher","first-page":"793","DOI":"10.9745\/GHSP-D-21-00232\/-\/DCSUPPLEMENTAL","volume":"9","author":"I Yoon","year":"2021","unstructured":"Yoon I, et\u00a0al. Health sector resource mapping in Malawi: sharing the collection and use of budget data for evidence-based decision making. Glob Health Sci Pract. 2021;9(4):793\u2013803. https:\/\/doi.org\/10.9745\/GHSP-D-21-00232\/-\/DCSUPPLEMENTAL.","journal-title":"Glob Health Sci Pract"},{"key":"1030_CR39","doi-asserted-by":"publisher","unstructured":"Ng\u2019ambi W et\u00a0al. Factors associated with healthcare seeking behaviour for children in Malawi: 2016. Tropical Medicine & International Health 2020:25(12);1486\u20131495. ISSN: 1365-3156. https:\/\/doi.org\/10.1111\/TMI.13499.","DOI":"10.1111\/TMI.13499"},{"key":"1030_CR40","first-page":"84","volume":"39","author":"E Connolly","year":"2024","unstructured":"Connolly E, et\u00a0al. Revision of Malawi\u2019s Health Benefits Package: a critical analysis of policy formulation and implementation. Value Health Reg Issues. 2024;39:84\u201394.","journal-title":"Value in Health Reg Issues"},{"issue":"10","key":"1030_CR41","doi-asserted-by":"publisher","first-page":"e1638","DOI":"10.1016\/S2214-109X(24)00259-6","volume":"12","author":"TD Mangal","year":"2024","unstructured":"Mangal TD, et\u00a0al. Assessing the effect of health system resources on HIV and tuberculosis programmes in Malawi: a modelling study. Lancet Glob Health. 2024;12(10):e1638\u201348. https:\/\/doi.org\/10.1016\/S2214-109X(24)00259-6.","journal-title":"Lancet Glob Health"},{"issue":"5","key":"1030_CR42","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PCBI.1007893","volume":"16","author":"CM Hazelbag","year":"2020","unstructured":"Hazelbag CM, et\u00a0al. Calibration of individual-based models to epidemiological data: a systematic review. PLoS Comput Biol. 2020;16(5):e1007893. https:\/\/doi.org\/10.1371\/JOURNAL.PCBI.1007893.","journal-title":"PLoS Comput Biol"},{"issue":"1","key":"1030_CR43","doi-asserted-by":"publisher","first-page":"35","DOI":"10.2165\/11584600-000000000-00000\/FIGURES\/5","volume":"29","author":"T Vanni","year":"2011","unstructured":"Vanni T, et\u00a0al. Calibrating models in economic evaluation: a seven-step approach. Pharmacoeconomics. 2011;29(1):35\u201349. https:\/\/doi.org\/10.2165\/11584600-000000000-00000\/FIGURES\/5.","journal-title":"Pharmacoeconomics"},{"key":"1030_CR44","doi-asserted-by":"publisher","unstructured":"Dieleman JL et\u00a0al. US spending on personal health care and public health, 1996-2013. JAMA 2016;316(24):2627\u20132646. ISSN: 0098-7484. https:\/\/doi.org\/10.1001\/JAMA.2016.16885. https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2594716.","DOI":"10.1001\/JAMA.2016.16885"},{"key":"1030_CR45","unstructured":"McDonald S et\u00a0al. Projecting healthcare expenditure to 2033\/34. Tech. Rep. Institute for Public Policy Research, Sept. 2023. https:\/\/www.lcp.com\/media\/1150633\/ippr_nhs_funding_scenarios.pdf?t."},{"key":"1030_CR46","doi-asserted-by":"publisher","unstructured":"Dieleman JL et\u00a0al. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40. Lancet (London, England) 2018;391(10132):1783\u20131798. ISSN: 1474-547X. https:\/\/doi.org\/10.1016\/S0140-6736(18)30697-4. https:\/\/pubmed.ncbi.nlm.nih.gov\/29678341\/. Accessed 20 Jan 2025.","DOI":"10.1016\/S0140-6736(18)30697-4"},{"key":"1030_CR47","doi-asserted-by":"publisher","unstructured":"Apeagyei AE et\u00a0al. Financing health in sub-Saharan Africa 1990\u20132050: donor dependence and expected domestic health spending. PLOS Global Public Health 2024;4(8): e0003433. ISSN: 2767-3375. https:\/\/doi.org\/10.1371\/JOURNAL.PGPH.0003433.","DOI":"10.1371\/JOURNAL.PGPH.0003433"},{"key":"1030_CR48","unstructured":"McCord J, Tien M, Sarley D. Guide to public health supply chain costing: a basic methodology. Tech. Rep. Arlington, VA: USAID \u2014 DELIVER PROJECT, Task Order 4, 2013."},{"issue":"7","key":"1030_CR49","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PMED.1001247","volume":"9","author":"G Meyer-Rath","year":"2012","unstructured":"Meyer-Rath G, Over M. HIV treatment as prevention: modelling the cost of antiretroviral treatment-state of the art and future directions. PLoS Med. 2012;9(7):e1001247. https:\/\/doi.org\/10.1371\/JOURNAL.PMED.1001247.","journal-title":"PLoS Med"},{"key":"1030_CR50","unstructured":"WHO Essential Items Estimator Tool. https:\/\/partnersplatform.who.int\/tools\/essentialitemsestimator. Accessed 9 Dec 2024."},{"key":"1030_CR51","unstructured":"UNICEF. Supply catalogue. 2024. https:\/\/supply.unicef.org\/all-materials\/pharmaceuticals.html. Accessed 9 Dec 2024."},{"key":"1030_CR52","unstructured":"Global Drug Facility. Product catalogue: first, second and third line anti-TB medicines. Tech. Rep. Geneva: Stop TB partnership, 2023. https:\/\/stoptb.org\/assets\/documents\/gdf\/who_stoptb_gdf_prod_a4.pdf. Accessed 1 Dec 2025."},{"key":"1030_CR53","doi-asserted-by":"crossref","unstructured":"Pradhan S. Evaluating public spending : a framework for public expenditure reviews. Tech. Rep. Washington D.C.: The World Bank, 1996, p. 134. https:\/\/documents.worldbank.org\/en\/publication\/documents-reports\/documentdetail\/509221468740209997. Accessed 1 Dec 2025.","DOI":"10.1596\/0-8213-3633-9"},{"key":"1030_CR54","unstructured":"World Health Organisation (WHO). Health Expenditure Tracking. https:\/\/www.who.int\/teams\/health-financing-and-economics\/health-financing\/expenditure-tracking. Accessed 1 Dec 2025."},{"key":"1030_CR55","unstructured":"Central Medical Stores Trust (CMST) Malawi. CMST Drug Price Catalogue. Tech. Rep. Lilongwe, 2023."},{"issue":"9","key":"1030_CR56","doi-asserted-by":"publisher","first-page":"145","DOI":"10.5897\/AJPP2015.4470","volume":"10","author":"F Khuluza","year":"2016","unstructured":"Khuluza F, et\u00a0al. Did drug availability in Malawian central hospitals improve after the conversion of central medical stores to a trust? Afr J Pharm Pharmacol. 2016;10(9):145\u201350. https:\/\/doi.org\/10.5897\/AJPP2015.4470.","journal-title":"Afr J Pharm Pharmacol"},{"key":"1030_CR57","unstructured":"Ministry of Health. Health Sector Strategic Plan - III (2023\u20132030). Tech. Rep. Lilongwe: Government of Malawi; 2023."},{"key":"1030_CR58","unstructured":"World Health Organisation (WHO). OneHealth Tool. https:\/\/www.who.int\/tools\/onehealth. Accessed 15 Jan 2025."},{"issue":"3","key":"1030_CR59","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1111\/trf.13405","volume":"56","author":"N Mafirakureva","year":"2016","unstructured":"Mafirakureva N, et\u00a0al. The costs of producing a unit of blood in Zimbabwe. Transfusion. 2016;56(3):628\u201336. https:\/\/doi.org\/10.1111\/trf.13405.","journal-title":"Transfusion"},{"issue":"3","key":"1030_CR60","doi-asserted-by":"publisher","first-page":"627","DOI":"10.4269\/AJTMH.17-0537","volume":"99","author":"R Stelmach","year":"2018","unstructured":"Stelmach R, et\u00a0al. Cost-effectiveness of indoor residual spraying of households with insecticide for malaria prevention and control in Tanzania. Am J Trop Med Hyg. 2018;99(3):627. https:\/\/doi.org\/10.4269\/AJTMH.17-0537.","journal-title":"Am J Trop Med Hyg"},{"key":"1030_CR61","doi-asserted-by":"publisher","unstructured":"Jablonski R et\u00a0al. Using remote tracking technologies to audit and understand medicine theft. Tech. Rep. Helsinki: UNU-WIDER, Oct. 2023. https:\/\/doi.org\/10.35188\/UNU-WIDER\/2023\/434-2. https:\/\/www.wider.unu.edu\/bibcite\/reference\/241429.","DOI":"10.35188\/UNU-WIDER\/2023\/434-2"},{"key":"1030_CR62","unstructured":"Ministry of Health. Resource Mapping Report Round 7. Tech. Rep. Lilongwe: Government of Malawi; 2023."},{"issue":"11","key":"1030_CR63","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PGPH.0000960","volume":"2","author":"GM Ruhago","year":"2022","unstructured":"Ruhago GM, et\u00a0al. The public health sector supply chain costs in Tanzania. PLOS Global Public Health. 2022;2(11):e0000960. https:\/\/doi.org\/10.1371\/JOURNAL.PGPH.0000960.","journal-title":"PLOS Global Public Health"}],"container-title":["Applied Health Economics and Health Policy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40258-026-01030-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40258-026-01030-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40258-026-01030-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:28:44Z","timestamp":1781173724000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40258-026-01030-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,3]]},"references-count":63,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["1030"],"URL":"https:\/\/doi.org\/10.1007\/s40258-026-01030-w","relation":{},"ISSN":["1175-5652","1179-1896"],"issn-type":[{"value":"1175-5652","type":"print"},{"value":"1179-1896","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,3]]},"assertion":[{"value":"3 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"S.M. reports grants from the NIH and Global Institute for Disease Elimination outside the submitted work. T.C. reports grants from The Global Fund for AIDS, TB and Malaria outside the submitted work. A.P. reports grants from the NIH, NIHR, EU, and Gates Foundation, and personal fees from the World Health Organisation, outside the submitted work. L.S. reports grants from the Swedish International Development Cooperation Agency and UNICEF during the conduct of the study. T.B.H. reports grants from MRC during the conduct of the study. All other authors report no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"The data and scripts used to generate the cost estimates, calibration outputs and scenario analyses in this study are publicly available in a GitHub repository:\n                      \n                      . The specific scripts and data used to produce the results presented in this paper can be accessed in the\n                      \n                      and\n                      \n                      folders, respectively. To ensure reproducibility, the exact version of the data and scripts used for this analysis has been archived on Zenodo as\n                      mohan-system-wide-costs-2026\n                      , available at\n                      \n                      . Facility survey data on operating costs were obtained from the Thanzi La Mawa (TLM) health facility audit and are available in a publicly accessible repository at\n                      \n                      . No restrictions apply to the access or use of this material. All data used in this study are either publicly available or provided in the supplementary files.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Materials"}},{"value":"This study primarily uses secondary data sources. Ethical approval for the primary data collection informing this analysis (specifically the Thanzi La Mawa (TLM) health facility audit) was granted by the Kamuzu University of Health Sciences Research Ethics Committee (COMREC) on 15 November 2023 (protocol no. P.09\/23-0297). Kamuzu University of Health Sciences conducted the data collection and served as the study sponsor.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained from all facility in-charges participating in the health facility audit interviews. No patient-level interview or health worker observational data from the TLM Study Datasets was used as part of this study. All data were collected and stored in anonymised form, and no personally identifiable information is included in this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Consent for publication was obtained as part of the informed consent process. All data used in this study were anonymised prior to analysis, and no personally identifiable information is included in this manuscript.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Publish"}},{"value":"SM: conceptualisation, methods, data curation, formal analysis, visualisation and writing the original draft. NC: data curation and reviewing and editing the manuscript; SW: methods, reviewing and editing the manuscript; CAA: reviewing and editing the manuscript; MC: methods, reviewing and editing the manuscript; JC: methods, reviewing and editing the manuscript; EC: reviewing and editing the manuscript; TC: methods, reviewing and editing the manuscript; EJ: methods, reviewing and editing the manuscript; TDM: methods, reviewing and editing the manuscript; GM: reviewing and editing the manuscript, JMB: funding acquisition, MM: methods, reviewing and editing the manuscript; DN: methods, reviewing and editing the manuscript; AP: methods, reviewing and editing the manuscript, LS: reviewing and editing the manuscript; BS: data curation, methods, and reviewing and editing the manuscript; WT: reviewing and editing the manuscript; PDT: reviewing and editing the manuscript; PR: supervision and funding acquisition; TBH: conceptualisation, methods, reviewing and editing the manuscript, and funding acquisition. SM and TBH have accessed and verified the data and were responsible for the decision to submit the manuscript. All the authors had access to the data in the study and they accept responsibility to submit for publication.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author Contributions"}}]}}