1
|
Raj EA, Hebbar P, N Srinivas P, V Rao N, Gudi N, Brand A, Patil DS. Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol. Wellcome Open Res 2024; 8:351. [PMID: 39045314 PMCID: PMC11263902 DOI: 10.12688/wellcomeopenres.19619.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Background A robust Health Technology Assessment (HTA) framework is crucial to address the rising burden of healthcare costs and to inform decision-making to promote high-quality health systems. This research aims to describe the HTA methods and mechanisms for the successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Methods Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. Conclusions To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.
Collapse
Affiliation(s)
- Elstin Anbu Raj
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Pragati Hebbar
- Cluster on Chronic Conditions and Public Policies, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | - Prashanth N Srinivas
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | - Neethi V Rao
- Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
- Independent Consultant, Bengaluru, India
| | - Nachiket Gudi
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, 6200 MD, The Netherlands
| | - Angela Brand
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, 6200 MD, The Netherlands
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht University, Maastricht, Limburg, NL - 6211 AX, The Netherlands
| | - Divya Sussana Patil
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
2
|
Tekpınar L, Yiğit V. Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye. Value Health Reg Issues 2024; 42:100979. [PMID: 38340673 DOI: 10.1016/j.vhri.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye. METHODS Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created. RESULTS Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06. CONCLUSIONS These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research's findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.
Collapse
Affiliation(s)
- Lütfiye Tekpınar
- Department of Health Economics, Nezahat Keleşoğlu Faculty of Health Sciences, Necmettin Erbakan University, Konya, Türkiye; Department of Health Management, Nezahat Keleşoğlu Faculty of Health Sciences, Necmettin Erbakan University, Konya, Türkiye.
| | - Vahit Yiğit
- Department of Hospital Management, Faculty of Economics and Administrative Sciences, Süleyman Demirel University, Isparta, Türkiye; Department of Health Management, Faculty of Economics and Administrative Sciences, Süleyman Demirel University, Isparta, Türkiye
| |
Collapse
|
3
|
Khan S, Ahmad Javid S, Ur Rehman S, Akhtar Y, Amir Khan M. A Systematic Review of Cost-Effectiveness Analyses Examining Treatments for Cachexia Syndrome. Nutr Cancer 2024; 76:584-595. [PMID: 38801296 DOI: 10.1080/01635581.2024.2353939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES This systematic review aims to critically evaluate and synthesize the economic outcomes of various therapeutic strategies employed to manage cachexia patients. METHODS A comprehensive search for randomized controlled trials and observational studies was conducted from January 1, 2000 to December 31, 2023, using PubMed, Google Scholar, Clinical Trials Registry, Cochrane Central Register of Controlled Trials, British Medical Journal, National Health Service Economic Evaluation Database, and ScienceDirect, following PRISMA guidelines. We assessed the quality of the included studies using the Consolidated Health Economic Evaluation Reporting Standards reporting guidelines. RESULTS We identified six high to medium quality economic evaluations in four countries, focusing on cancer, chronic obstructive pulmonary disease, and HIV/AIDS-associated cachexia. The results indicate that combination management strategies, specifically the use of nutritional supplements and exercise, are more cost-effective than usual care for cachexia syndrome. Additionally, two studies showed that dietary supplements alone were more cost-effective than usual care, and pharmacotherapy alone was more cost-effective than a placebo. CONCLUSION Combining several strategies, such as nutritional supplements and exercise, may be the most economically efficient method for managing cachexia compared to usual care or single treatment approaches. However, the restricted and diverse characteristics of the current research hinder the definitive conclusions.
Collapse
Affiliation(s)
- Safeer Khan
- Department of Pharmaceutical Sciences, Institute of Chemical Sciences, Government College University, Lahore, Punjab, Pakistan
| | | | - Sabi Ur Rehman
- Department of Pharmacy, Foreman Christian College (A Chartered University), Lahore, Punjab, Pakistan
| | - Yasmeen Akhtar
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Muhammad Amir Khan
- Department of Foreign Medical Education, Fergana Institute of Public Health, Fergana, Uzbekistan
| |
Collapse
|
4
|
Tefera BB, Demsie DG, Yehualaw A, Tafere C, Feyisa K, Yismaw MB, Kefale B, Yilma Z. Characteristics and Quality Appraisal of the Economic Evaluations Done in Ethiopia: A Systematic Review. PHARMACOECONOMICS - OPEN 2023; 7:877-886. [PMID: 37624553 PMCID: PMC10721755 DOI: 10.1007/s41669-023-00433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Health economic evaluation identifies, measures, values, and compares alternative strategies to efficiently allocate scarce resources. The validity, methodological quality, and generalizability of economic evaluations must be assessed, as poorly designed studies can lead to incorrect conclusions. Therefore, this study aimed to evaluate the quality and characteristics of published economic evaluations done in Ethiopia, using the Quality of Health Economics Studies (QHES) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments. METHODOLOGY Various electronic databases were searched using different keywords. We included only original studies conducted in Ethiopia that evaluated the cost and consequences of at least two health interventions. Abstracts, treatment guidelines, reviews, expert opinions, and studies that included other countries were excluded. Two reviewers independently evaluated each study using the QHES and CHEERS instruments and any disagreements were then resolved by a third reviewer. RESULT The study included 21 studies published between 2002 and 2021. HIV was the most frequently evaluated medical condition, examined in four (19.06%) of the 21 studies. Seventeen of the studies (80.95%) compared healthcare services or programs, while the other four examined pharmaceutical products. Cost-utility analysis was the economic evaluation technique used in 14 studies (66.67%). Of the studies that disclosed their funding sources, foreign institutions were involved in funding 71.43% of them. Disability-adjusted life-year (DALY) was an outcome metric used in nine (42.86%) studies. The average QHES score of the studies was 82%. Fourteen studies had QHES scores of ≥75% and two had scores of <50%. The studies evaluated using the CHEERS instrument ranged in quality from 42.9% to 92.9%, with an average of 78.23%. CONCLUSION Our study revealed that Ethiopia lacks health economic evaluations, particularly on non-communicable diseases. This indicates that the economic evaluation of healthcare interventions in Ethiopia is still in its early stages. Additionally, Ethiopian institutions have played a very limited role in funding research, highlighting the importance of active participation from local institutions.
Collapse
Affiliation(s)
| | | | - Adane Yehualaw
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Chernet Tafere
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Kebede Feyisa
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | | | - Belayneh Kefale
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Zewdu Yilma
- Bahir Dar University College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| |
Collapse
|
5
|
Hassan AYI, Cucculelli M, Lamura G. Caregivers' willingness to pay for digital support services: Comparative survey. Health Policy 2023; 130:104751. [PMID: 36857837 DOI: 10.1016/j.healthpol.2023.104751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Considering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers' willingness to pay for digital support services is needed. OBJECTIVE The aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden. METHODS A sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver's demographics, caregiver's socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay. RESULTS More than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers' willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057). CONCLUSIONS Factors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers' willingness to pay for digital support services. The digital and social divide may negatively affect caregivers' willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers' health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.
Collapse
Affiliation(s)
- Alhassan Yosri Ibrahim Hassan
- INRCA IRCCS - National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy; Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Marche Polytechnic University, Ancona, Italy.
| | - Marco Cucculelli
- Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Lamura
- INRCA IRCCS - National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy
| |
Collapse
|
6
|
Ghia C, Rambhad G. Implementation of equity and access in Indian healthcare: current scenario and way forward. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2194507. [PMID: 36998432 PMCID: PMC10044314 DOI: 10.1080/20016689.2023.2194507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The Indian healthcare system is evolving towards better healthcare implementation and coverage. However, even today, the health-care system faces several challenges, a few of which are yet to be addressed. The present review is aimed to delineate the past and present healthcare scenarios in India, health-care policies, and other initiatives for achieving universal health coverage (UHC). METHODS A literature search was done on various government databases, websites, and PubMed for obtaining data and statistics on healthcare funding, health insurance schemes, healthcare budget allocations, categories of medical expenses, government policies, and health technology assessment (HTA) in India. RESULTS The available data indicates 37.2% of the total population is covered by any health insurance of which 78% are covered by public insurance companies. Around 30% of the total health expenditure is borne by the public sector, and there is high out-of-pocket (OOP) expenditure on healthcare. DISCUSSION Several new health policies and schemes, an increase in 2021 budget for healthcare by 137%, vaccination drives, augmenting manufacturing of medical devices, special training packages, Artificial Intelligence/Machine Learning (AI/ML)-based standard treatment workflow systems to ensure proper treatment and clinical decision-making have been initiated by the government for improving healthcare funding, equity, and access.
Collapse
Affiliation(s)
- Canna Ghia
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| | - Gautam Rambhad
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| |
Collapse
|
7
|
Çoban M, Bilge U, Balseven H, Uysal H, Artut B. The economic evaluation of ALS care: quality and cost. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-12. [PMID: 36794629 DOI: 10.1080/21678421.2023.2176776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Objective: The study aims to analyze the quality of studies that make economic evaluations for amyotrophic lateral sclerosis (ALS). Assessing the quality of studies can guide policy-making and planning. Methods: One of the most recognized checklists "The Consensus on Health Economic Criteria" (CHEC)-list designed by Evers et al. in 2005 aims to answer two important questions: is the methodology of the study appropriate, and are the results of the study valid? We reviewed studies focusing on ALS and its economic costs, and evaluated the studies with (CHEC)-list. Results: We examined 25 articles in terms of their cost evaluation and quality. It is seen that they mainly focus on medical costs, ignoring social care costs. When the quality of the studies is examined, it is seen that the studies overall achieve high scores in terms of their purpose and research question, but some of the studies score low in terms of ethical dimension, comprehensiveness of expenditure items, their application of sensitivity analyses and their study design. Conclusions: The main recommendation of our study for future cost evaluation studies is that they should focus on the questions in the checklist that are scored low overall by the 25 articles, and consider the social care costs as well as medical costs. Our recommendations when designing cost studies can be applied to other chronic diseases with long-term economic costs like ALS.
Collapse
Affiliation(s)
- Mustafa Çoban
- Department of Healthcare Management, Health Sciences Faculty, Akdeniz University, Antalya, Turkey
| | - Uğur Bilge
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Hale Balseven
- Department of Public Finance, Faculty of Economics and Administrative Sciences, Akdeniz University, Antalya, Turkey
| | - Hilmi Uysal
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey, and
| | - Betül Artut
- Mediterranean Migration Studies, Mediterranean Civilisations Research Institute, Akdeniz University, Antalya, Turkey
| |
Collapse
|
8
|
Emmert-Fees KM, Laxy M, Patel SA, Singh K, Poongothai S, Mohan V, Chwastiak L, Narayan KV, Sagar R, Sosale AR, Anjana RM, Sridhar GR, Tandon N, Ali MK. Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India. Diabetes Care 2023; 46:11-19. [PMID: 36383487 PMCID: PMC9797643 DOI: 10.2337/dc21-2533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of collaborative versus usual care in adults with poorly controlled type 2 diabetes and depression in India. RESEARCH DESIGN AND METHODS We performed a within-trial cost-effectiveness analysis of a 24-month parallel, open-label, pragmatic randomized clinical trial at four urban clinics in India from multipayer and societal perspectives. The trial randomly assigned 404 patients with poorly controlled type 2 diabetes (HbA1c ≥8.0%, systolic blood pressure ≥140 mmHg, or LDL cholesterol ≥130 mg/dL) and depressive symptoms (9-item Patient Health Questionnaire score ≥10) to collaborative care (support from nonphysician care coordinators, electronic registers, and specialist-supported case review) for 12 months, followed by 12 months of usual care or 24 months of usual care. We calculated incremental cost-effectiveness ratios (ICERs) in Indian rupees (INR) and international dollars (Int'l-$) and the probability of cost-effectiveness using quality-adjusted life-years (QALYs) and depression-free days (DFDs). RESULTS From a multipayer perspective, collaborative care costed an additional INR309,558 (Int'l-$15,344) per QALY and an additional INR290.2 (Int'l-$14.4) per DFD gained compared with usual care. The probability of cost-effectiveness was 56.4% using a willingness to pay of INR336,000 (Int'l-$16,654) per QALY (approximately three times per-capita gross domestic product). The willingness to pay per DFD to achieve a probability of cost-effectiveness >95% was INR401.6 (Int'l-$19.9). From a societal perspective, cost-effectiveness was marginally lower. In sensitivity analyses, integrating collaborative care in clinical workflows reduced incremental costs by ∼47% (ICER 162,689 per QALY, cost-effectiveness probability 89.4%), but cost-effectiveness decreased when adjusting for baseline values. CONCLUSIONS Collaborative care for patients with type 2 diabetes and depression in urban India can be cost-effective, especially when integrated in clinical workflows. Long-term cost-effectiveness might be more favorable. Scalability across lower- and middle-income country settings depends on heterogeneous contextual factors.
Collapse
Affiliation(s)
- Karl M.F. Emmert-Fees
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Hubert Department of Global Health, Emory University, Atlanta, GA
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Michael Laxy
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Hubert Department of Global Health, Emory University, Atlanta, GA
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Shivani A. Patel
- Hubert Department of Global Health, Emory University, Atlanta, GA
| | - Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India
| | - Subramani Poongothai
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | | | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Aravind R. Sosale
- Diabetes Care and Research Center, DIACON Hospital, Bangalore, Karnataka, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
9
|
Meenakshi Sundaram C, Seethapathy J. Infection Control and Hygienic Measures Practiced Among Audiologists in India. Indian J Otolaryngol Head Neck Surg 2022; 74:3541-3559. [PMID: 36742729 PMCID: PMC9895510 DOI: 10.1007/s12070-020-01799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Audiologists extend their services to wide range of patients who vary across several factors like age, disease, nutritional status, pharmacological intervention, socioeconomic status and compromised immune systems. This involves direct or indirect contact with patients exposing the clinician to blood, and other bodily fluids which are considered to be potentially infectious substances. Thus infection control activities must be stressed with the goal of reducing or preventing the transmission of nosocomial pathogens to patients and staff. The aim of the study is to provide an in-depth assessment of current infection control strategies and hygienic measures followed among Audiologists in India. An internet based questionnaire survey was done among 172 Audiologists. The questionnaire focused on four domains: demography; knowledge, attitude and practice of infection control and hygienic measures followed in audiology clinic. Majority of the participants had a positive attitude towards infection control practice. Though most of them had an access to gloves (73.3%) and masks (60%), their usage was minimal and restricted to selected procedures. Hand hygienic measures were practiced by 89% of the participants only during few procedures. Irrespective of critical or non-critical instruments, majority of the participants preferred cleaning and disinfecting. Sterilisation of critical instruments was performed only by 30% of the audiologists. Audiologists knowledge and practice of infection control and hygienic measures was found to be inadequate. Specialized training program on infection control strategies should be targeted to the newly graduated and practicing audiologists to ensure patient safety and infection free clinical environment.
Collapse
Affiliation(s)
| | - Jayashree Seethapathy
- Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 600 116 India
| |
Collapse
|
10
|
Impact of Health Technology Assessment Implementation with Special Focus on Middle-Income Countries. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
11
|
Sefuthi T, Nkonki L. A systematic review of economic evaluations of cervical cancer screening methods. Syst Rev 2022; 11:162. [PMID: 35945642 PMCID: PMC9361672 DOI: 10.1186/s13643-022-02017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear. INTRODUCTION Cervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods. METHODS This review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised. RESULTS From a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method. CONCLUSIONS Existing evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020212454 .
Collapse
Affiliation(s)
- Thatohatsi Sefuthi
- Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Lungiswa Nkonki
- Health Economics, Division of Health Systems and Public Health, Global Health Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
12
|
Medical Students’ Perception Regarding Health Policy Teaching and Their Participation in Health Policy Roles: A Survey at a Public University in Malaysia. Healthcare (Basel) 2022; 10:healthcare10060967. [PMID: 35742019 PMCID: PMC9223141 DOI: 10.3390/healthcare10060967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/14/2022] [Accepted: 05/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Health policy is a set of comprehensive principles and legislations that guide how healthcare should be effectively delivered in the community. Medical schools should prepare students to undertake managerial responsibilities by incorporating health policy into the curriculum to deal with the intricacies of healthcare systems and their clinical roles in their future professional careers. Objective: To examine medical students’ perception at a Public University in Malaysia regarding teaching health policy and their participation in health policy roles. Material and Methods: A cross-sectional study using universal sampling was carried out among the medical students using a paper-based questionnaire to collect the data. Results: Most respondents opined their willingness to learn health policy (80.9%) and that teaching health policy (83.6%) should be compulsory for medical students. The respondents thought health policy should be introduced earlier in Year 1 or 2. The student scores on their knowledge regarding health policy and year of study were significantly associated with their involvement in the health policy roles in both the simple and multiple logistic regression. Both statistical tests reported higher participation in health policy roles with the higher year of study, though only Year 4 and 5 were significant in the simple logistic regression and only Year 5 in the multiple logistic regression compared to Year 1. On the other hand, age and type of admission show significant results only in the simple logistic regression, while the race was only significant at the multivariate level. Conclusions: This study demonstrated that most respondents showed their willingness to learn health policy, participate in the health policy programs, and recommend that health policy be considered an essential topic in the medical curriculum, which should be taught right from the first year of medical school. We recommend encouraging students’ participation in health policy activities.
Collapse
|
13
|
Doran CM, Bryant J, Langham E, Bainbridge R, Begg S, Potts B. Scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs: a systematic review. Aust N Z J Public Health 2022; 46:361-369. [PMID: 35298065 DOI: 10.1111/1753-6405.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/01/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Identify the number, type, scope and quality of economic evaluations of Aboriginal and Torres Strait Islander health programs. METHODS A systematic review of peer-reviewed and grey literature was conducted for articles published from 2010 to 2020 that reported a full economic evaluation of Aboriginal and Torres Strait Islander health programs. Data extraction included: type of economic evaluation, comparators, data sources and concerns, and outcome measures. Methodological quality was assessed using the Drummond checklist. RESULTS Thirteen publications met inclusion criteria: two cost-consequence analyses, two cost-effectiveness analyses, five cost-utility analyses, and four cost-benefit/return on investment analyses. Most studies (n=10) adopted a health system perspective and used a range of key data sources for economic analyses. Ten studies identified data access limitations that restricted analyses and two studies identified data quality concerns. Twelve studies were of good methodological quality and one was of average quality. CONCLUSIONS Despite significant investment in strategies to close the gap in health outcomes for Aboriginal and Torres Strait Islander people, there is limited evidence about what constitutes a cost-effective investment in Aboriginal and Torres Strait Islander healthcare. IMPLICATIONS FOR PUBLIC HEALTH More economic evaluation is required to justify the significant investment in health programs for Aboriginal and Torres Strait Islander people.
Collapse
Affiliation(s)
- Christopher M Doran
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Queensland.,Centre for Indigenous Health Equity Research, Central Queensland University, Queensland
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Medicine and Wellbeing, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Erika Langham
- School of Population Health, University of Queensland, Queensland
| | - Roxanne Bainbridge
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Queensland
| | - Stephen Begg
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Victoria
| | - Boyd Potts
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Queensland.,Centre for Indigenous Health Equity Research, Central Queensland University, Queensland
| |
Collapse
|
14
|
Gupta S, Tiwari R, Goel R. A retrospective cross-sectional descriptive study to critically appraise the quality of reporting of health economic evaluations conducted in the Indian setting. Perspect Clin Res 2022; 13:25-32. [PMID: 35198425 PMCID: PMC8815666 DOI: 10.4103/picr.picr_137_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background: The reporting quality of economic research could benefit from enhanced quality assurance procedures. At present, there are small numbers of health economic researches being conducted with Indian context or setting. There is not much clarity about the reporting quality of health economic researches being conducted with Indian context or setting. Objective: The primary objective is to of this study was to appraise the quality of reporting of health economic evaluations conducted in the Indian setting and published between January 2014 and December 2018. Materials and Methods: This was a retrospective, cross-sectional, descriptive analysis. The MEDLINE in PubMed, Google Scholar, and Science Direct were systematically searched to search for economic evaluations. The consolidated health economic evaluation reporting standards statement checklist was utilized to assess the quality of reporting of the included studies. For grading the quality of the included health economic assessments, the Quality of Health Evaluation Studies (QHES) instrument was used. Results: Thirty studies fulfilled the inclusion criteria and were included in the study. The mean QHES score was 80.26 (standard deviation = 8.06). Twenty-five (83.33%, 95% confidence interval [CI]: 0.66–0.92) of the article mentioned perspective of the study. Twenty-nine (96.66%, 95% CI: 0.83–0.99) of the article described the effects of uncertainty for all input parameters. Twenty (66.66%, 95% CI: 0.48–0.80) of the article reported all funding sources. Conclusions: Overall, the quality of reporting of the included health economic studies was good, which reemphasizes their usefulness in supporting the decision-making procedure about better medicine. The finding of this study will be a small step toward ensuring robust and high-quality health economics data in India.
Collapse
|
15
|
Popovici I, Carvajal MJ, Peeples P, Rabionet SE. Nature and Composition of Earnings Reported by Health Economists and Related Professionals: Gender, Education, and job Characteristics Matter. Health Serv Res Manag Epidemiol 2022; 9:23333928221106039. [PMID: 35769113 PMCID: PMC9234843 DOI: 10.1177/23333928221106039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite the fast growth of the workforce comprising health economics (HE),
outcomes research (OR), and market access (MA) professionals, little is
known about their earnings determination. Only three studies have examined
their earnings and none has considered the number of hours worked,
traditionally a critical component of income determination models. Objectives (i) Estimate an indicator of annual earnings of HE/OR/MA professionals,
comparing male versus female and U.S. versus non-U.S. earnings levels, and
(ii) assess the magnitude of the effect of selected human-capital and
job-related covariates on their annual earnings determination. Methods The study used 2019 self-reported survey data from a sample of 304 HE/OR/MA
professionals registered in the HealthEconomics.com global subscriber list.
A two-way classification model with multiple replications was used to
identify and test earnings variations of HE/OR/MA professionals across
genders and locations. An earnings determination function using ordinary
least squares was used to identify disparities in response to covariates
including average workweek, human-capital stock, and job-related variables
by gender and location. Results Substantial earning disparities were observed between HE/OR/MA professionals
living in the U.S. and those living in other countries. Non-U.S. respondents
exhibited earnings gaps of 44.7% in wages/salaries and 46.8% in total
earnings relative to their U.S. counterparts with greater gaps for women
than men. The female earnings gap outside the U.S. was considerably greater
than in the U.S. Holding a graduate degree; working in a pharmaceutical or
biotechnology firm; age, a proxy for experience; and working remotely
impacted earnings differentials across different subgroups. Conclusions The findings of this paper shed light into the nature and composition of
earnings of HE/OR/MA professionals across genders and locations. Exploring
the dynamics of earning disparities by gender and location has increased in
relevance given the rapidly-changing and uncertain job market environment
driven by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ioana Popovici
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, FL, USA
| | - Manuel J. Carvajal
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, FL, USA
| | - Patti Peeples
- Founder and CEO, HealthEconomics.com and Principal Researcher, HE Institute, Jacksonville, FL
| | - Silvia E. Rabionet
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, FL, USA
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| |
Collapse
|
16
|
Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol 2021; 22:e541-e549. [PMID: 34856151 DOI: 10.1016/s1470-2045(21)00468-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022]
Abstract
Although financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and outcome among the Indian population. In this study, we systematically reviewed the prevalence, determinants, and consequences of financial toxicity among patients with cancer in India. 22 studies were included in the systematic review. The determinants of financial toxicity include household income, type of health-care facility used, stage of disease, area of residence, age at the time of diagnosis, recurrent cancer, educational status, insurance coverage, and treatment modality. Financial toxicity was associated with poor quality of life, accumulation of debts, premature entry into the labour market, and non-compliance with therapy. Our findings emphasise the need for urgent strategies to mitigate financial toxicity among patients with cancer in India, especially in the most deprived sections of society. The qualitative evidence synthesised in this systematic review could provide a basis for the development of such interventions to reduce financial toxicity among patients with cancer.
Collapse
Affiliation(s)
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Aju Mathew
- Malankara Orthodox Syrian Church Medical College, Kolenchery, India.
| |
Collapse
|
17
|
Hubens K, Krol M, Coast J, Drummond MF, Brouwer WBF, Uyl-de Groot CA, Hakkaart-van Roijen L. Measurement Instruments of Productivity Loss of Paid and Unpaid Work: A Systematic Review and Assessment of Suitability for Health Economic Evaluations From a Societal Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1686-1699. [PMID: 34711370 DOI: 10.1016/j.jval.2021.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVES This study aimed (1) to perform a systematic literature review of instruments for measuring productivity loss of paid and unpaid work and (2) to assess the suitability (in terms of identification, measurement, and valuation) of these instruments for use in health economic evaluations from a societal perspective. METHODS Articles published from 2018 were sourced from PubMed/Medline, PsycInfo, Embase, and Econlit. Using 2 separate search strategies, eligible economic evaluations and validation studies were selected and unique measurement instruments identified. A data-extraction form was developed by studying previous literature and consulting an international panel of experts in the field of productivity costs. This data-extraction form was applied to assess the suitability of instruments for use in economic evaluations. RESULTS A total of 5982 articles were retrieved from the databases, of which 99 economic evaluations and 9 validation studies were included in the review. A total of 42 unique measurement instruments were identified. Nine instruments provided quantified measures of absenteeism, presenteeism, and unpaid work. Five instruments supplied the necessary information to enable the use of at least 1 common valuation method. The Health and Labour Questionnaire-Short Form, Health and Labour Questionnaire, and Institute for Medical Technology Assessment Productivity Cost Questionnaire met both criteria. Nevertheless, the developers replaced the Health and Labour Questionnaire-Short Form and Health and Labour Questionnaire by the more recently developed Institute for Medical Technology Assessment Productivity Cost Questionnaire. CONCLUSIONS Although many instruments for measuring productivity loss were identified, most were not suitable for capturing productivity changes for economic evaluations from a societal perspective. Future research can benefit from this study by making an informed instrument choice for the measurement of productivity loss of paid and unpaid work.
Collapse
Affiliation(s)
- Kimberley Hubens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | | | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | | | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | |
Collapse
|
18
|
Popovici I, Carvajal MJ, Peeples P, Rabionet SE. Disparities in the Wage-and-Salary Earnings, Determinants, and Distribution of Health Economics, Outcomes Research, and Market Access Professionals: An Exploratory Study. PHARMACOECONOMICS - OPEN 2021; 5:319-329. [PMID: 33428118 PMCID: PMC7797494 DOI: 10.1007/s41669-020-00247-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The aim was to estimate the wage-and-salary earnings of a sample of health economics, outcomes research, and market access (HE/OR/MA) professionals; compare male versus female and US versus non-US earnings; assess the magnitude of the effect of several human-capital and job-related covariates on the determination of earnings; and examine inequality in the distribution of earnings. METHODS The study used self-reported survey data collected in 2017 from a subset of HE/OR/MA professionals in the HealthEconomics.com global subscriber list. HE/OR/MA professionals in this subset completed a questionnaire. The sample consisted of 372 participants who reported their wage-and-salary earnings and other indicators. The sample was not necessarily representative of the global HE/OR/MA community. The study methods included a two-way classification model with multiple replications, an ordinary least-squares model, and three inequality indicators. PRINCIPAL FINDINGS The results suggested substantial disparities between the wage-and-salary earnings of respondents living in the USA and those living in other countries; mild gender disparities in earnings; greater inequality outside the USA than within the USA; and, within each location, more unequal distribution of men's earnings than that of women's earnings. CONCLUSIONS Although the findings may not be extrapolated to the worldwide population of HE/OR/MA professionals, they provide a point of comparison with earlier studies and offer insights into the mechanics of one of the most innovative and fastest growing health-sector workforce segments in developed as well as emerging countries.
Collapse
Affiliation(s)
- Ioana Popovici
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328-2018 USA
| | - Manuel J. Carvajal
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328-2018 USA
| | - Patti Peeples
- HE Institute, HealthEconomics.com, 1327 Walnut Street, Jacksonville, 32206 FL USA
| | - Silvia E. Rabionet
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328-2018 USA
- University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, 00936-5067 Puerto Rico USA
| |
Collapse
|
19
|
Muniyandi M, Lavanya J, Karikalan N, Saravanan B, Senthil S, Selvaraju S, Mondal R. Estimating TB diagnostic costs incurred under the National Tuberculosis Elimination Programme: a costing study from Tamil Nadu, South India. Int Health 2021; 13:536-544. [PMID: 33570132 PMCID: PMC8643484 DOI: 10.1093/inthealth/ihaa105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background The National Tuberculosis Elimination Programme (NTEP) of India is aiming to eliminate TB by 2025. The programme has increased its services and resources to strengthen the accurate and early detection of TB. It is important to estimate the cost of TB diagnosis in India considering the advancement and implementation of new diagnostic tools under the NTEP. The objective of this study was to estimate the unit costs of providing TB diagnostic services at different levels of public health facilities with different algorithms implemented under the NTEP in Chennai, Tamil Nadu, South India. Methods This costing study was conducted from the perspective of the health system. This study used only secondary data and information that were available in the public domain. Data were collected with the approval of health authorities. The patient's diagnostic path from the point of registration until the final diagnosis was considered in the costing exercise. The unit costs of different diagnostic tools used in the NTEP implemented by Chennai Corporation were calculated. Results We estimated the unit cost of the eight laboratory tests (Ziehl–Neelsen [ZN], fluorescence microscopy [FM], x-ray, digital x-ray, gene Xpert MTB/RIF (cartridge-based nucleic acid amplification test [NAAT] that identifies rifampicin resistant Mycobacterium Tuberculosis) Mycobacterium Tuberculosis/Rifampicin [MTB/RIF], mycobacteria growth indicator tube [MGIT], line probe assay [LPA] and Lowenstein Jensen [LJ] culture) for diagnosis of drug-sensitive and drug-resistant TB. The unit costs included fixed and variable costs for smear examination by ZN microscopy (₹ [Indian Rupee] 326 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}4.72], FM (₹104 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}1.5]), x-ray (₹218 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}3.15]), digital X-ray (₹281 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}4.07]), gene Xpert MTB/RIF (₹1137 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}16.47]), MGIT (₹7038 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}102]), LPA (₹6448 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}93.44]) and LJ culture (₹4850 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}70.28]). Out of 10 diagnostic algorithms used for TB diagnosis, algorithms using only smear microscopy had the lowest cost, followed by smear microscopy with x-ray for drug-sensitive TB (₹104 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}1.5] to ₹544 [US\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}${\$}$\end{document}7.88]). Diagnostic algorithms for drug-resistant TB involving LPA and gene Xpert MTB/RIF were the most expensive. Conclusions Understanding the various costs contributing to TB diagnosis in India provides crucial evidence for policymakers, programme managers and researchers to optimise programme spending and efficiently use resources.
Collapse
Affiliation(s)
| | - Jayabal Lavanya
- District TB Office, National TB Elimination Programme, Chennai
| | - Nagarajan Karikalan
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Balakrishnan Saravanan
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Sellappan Senthil
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Sriram Selvaraju
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai
| | - Rajesh Mondal
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai
| |
Collapse
|
20
|
Kaczmarek K, Romaniuk P. The use of evaluation methods for the overall assessment of health policy: potential and limitations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:43. [PMID: 33061858 PMCID: PMC7552366 DOI: 10.1186/s12962-020-00238-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of public policies requires special attention from public authorities to ensure their transparency, effectiveness and efficiency. For this reason, efforts to evaluate the abovementioned politics gained attention and importance. Similar processes, by their very nature, are also noticeable in the area of health policy, however, the nature of the solutions used raises questions about the extent to which they allow to capture the assessed phenomenon in a holistic way. The current approach to the problem of evaluating health policy shows a tendency to break down this phenomenon into components including policies, programs or projects. The purpose of this publication was to assess the main methodological approaches used in evaluation studies in terms of their usefulness and limitations in conducting overall assessment of health policy. Main body The publication divides evaluation methods based on three main criteria identified in the literature—time, purpose and scope of evaluation. Methodological approaches to evaluation activities detailed on this basis are discussed from the point of view of their characteristics, usefulness and limitations in the creation of comprehensive health policy assessments. The growing awareness of the need for a different approach to evaluation, which was confirmed by the course of the discourse on evaluation in public health, was also pointed out. Conclusion Given the complexity of the matter making up the health policy, attempts aimed at its overall assessment should be based on an approach integrating many approaches, while ensuring coordination of evaluation activities that should be subject to common assumptions.
Collapse
Affiliation(s)
- Krzysztof Kaczmarek
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| |
Collapse
|
21
|
Kuwawenaruwa A, Wyss K, Wiedenmayer K, Tediosi F. Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania. BMJ Glob Health 2020; 5:bmjgh-2020-002681. [PMID: 32928801 PMCID: PMC7490950 DOI: 10.1136/bmjgh-2020-002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/24/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Economic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as ‘Jazia Prime Vendor System’ (Jazia PVS)). Methods Financial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014–July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018–2019). A multivariate sensitivity analysis was conducted on the estimates. Results Jazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37. Conclusion In conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities.
Collapse
Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .,University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Kaspar Wyss
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Karin Wiedenmayer
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Health Promotion and System Strengthening (HPSS) project, Dodoma, United Republic of Tanzania
| | - Fabrizio Tediosi
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| |
Collapse
|
22
|
Öztürk Yıldırım T, Baykal Ü, Türkmen E. Determining nursing service management standards in Turkey: A Delphi study. J Nurs Manag 2020; 28:1635-1643. [PMID: 32761707 DOI: 10.1111/jonm.13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the current management standards needed by nurse managers in Turkey and to share the process of establishing standards. BACKGROUND Relevant and utilizable nursing management standards are needed for effective and efficient nursing administration to achieve better outcomes in health care. METHODS A three-round e-Delphi method was used in this study. First, the experts were asked an open-ended question. In the second and third rounds, data analysis measurements included item-by-item per cent agreement, standard deviation, average, median and interquartile range. RESULTS At the end of the third round, 49 standards were obtained under five main standards for nurse managers: management and organisation; leadership; human resources management; quality management; and professionalism. CONCLUSION The results of this study, which represent a consensus on nursing management standards drawn from the views of experts across regions and institutions in Turkey, provide a baseline to design, manage and evaluate nursing services. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management standards, which are fundamental for designing, leading and evaluating nursing services, give a framework for nurse managers to provide effective and efficient administrative practices.
Collapse
Affiliation(s)
- Tuğba Öztürk Yıldırım
- Vocational School of Health Care Services, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Ülkü Baykal
- Nursing Management Department, Istanbul University-Cerrahpaşa Florence Nightingale School of Nursing, Istanbul, Turkey
| | - Emine Türkmen
- Semahat Arsel Nursing Education & Research Center (SANERC), Koc University School of Nursing, Istanbul, Turkey
| |
Collapse
|
23
|
Uzochukwu BSC, Okeke C, O’Brien N, Ruiz F, Sombie I, Hollingworth S. Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders' capacity, needs, policy areas of demand and perspectives in Nigeria. Global Health 2020; 16:58. [PMID: 32641066 PMCID: PMC7346669 DOI: 10.1186/s12992-020-00583-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/17/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. METHODS We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. RESULTS Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially benefit from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system financing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management. CONCLUSION The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insufficient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identified training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidence-informed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.
Collapse
Affiliation(s)
- Benjamin S. C. Uzochukwu
- Department of Community medicine, College of Medicine, University of Nigeria Enugu Campus Nigeria, Enugu, Nigeria
| | - Chinyere Okeke
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG UK
| | - Niki O’Brien
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG UK
| | - Francis Ruiz
- International Decision Support Initiative (iDSI), Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG UK
| | - Issiaka Sombie
- West Africa Health Organisation, Organisation Ouest Africaine de la Santé, 175 avenue Ouezzin Coulibaly, Bobo-Dioulasso 01, 01 BP 153 Burkina Faso
| | | |
Collapse
|
24
|
Al-Awlaqi MA, Aamer AM. An integrated MUSA to measure health care service quality from a patient's perspective in a resource-constrained setting. Int J Health Plann Manage 2020; 35:e119-e132. [PMID: 31670407 DOI: 10.1002/hpm.2943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/16/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Although assessing the quality of health services offered in a least developed country such as Yemen is very important, it is not yet given attention. As a result, Yemeni patients started to look for higher quality of health services abroad. Thus, Yemeni health private providers need to know how to link their patients' satisfaction to the quality of the services offered to end up with more satisfied patients and higher health service quality offered. METHODOLOGY Data were collected form 5310 patients in 249 private clinics. The patients evaluated their satisfaction on the quality of service on the basis of nine criteria that comprised 31 subcriteria. We used multicriteria satisfaction analysis (MUSA) to analyze the data. FINDINGS AND CONCLUSION The data analysis results showed low level of satisfaction on the health care quality services offered by the private clinics in Yemen. The majority of the criteria and subcriteria showed low level of satisfaction, high demand, and high mandate for improvement.
Collapse
Affiliation(s)
| | - Ammar Mohamed Aamer
- Faculty of Engineering and Technology, Sampoerna University, Jakarta, Indonesia
| |
Collapse
|
25
|
Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent: efforts to 'Bridge the Gap'. Curr Opin Otolaryngol Head Neck Surg 2019; 27:212-218. [PMID: 30950835 DOI: 10.1097/moo.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society. RECENT FINDINGS Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country. SUMMARY Introduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.
Collapse
|
26
|
Sibhat SG, Fenta TG, Sander B, Gebretekle GB. Health-related quality of life and its predictors among patients with breast cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Health Qual Life Outcomes 2019; 17:165. [PMID: 31690327 PMCID: PMC6833153 DOI: 10.1186/s12955-019-1239-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/24/2019] [Indexed: 12/27/2022] Open
Abstract
Background Breast cancer is the second most prevalent malignancy in Ethiopia and severely affects patients’ health-related quality of life (HRQOL). We aimed to assess HRQoL, factors influencing HRQoL, and utilities among breast cancer patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods A hospital-based cross-sectional study was conducted in Tikur Anbessa Specialized Hospital from December 2017 to February, 2018. A total of 404 breast cancer patients were interviewed using the validated Amharic version of the European Organization for Research and Treatment of Cancer module (EORTC QLQ-C30), EORTC QLQ-BR23, and Euro Quality of Life Group’s 5-Domain Questionnaires 5 Levels (EQ-5D-5 L) instruments. Mean scores and mean differences of EORTC- QLQ-C30 and EORTC- QLQ-BR23 were calculated. One-way ANOVA test was employed to determine the significance of mean differences among dependent and independent variables while stepwise multivariate logistic regression was used to identify factors associated with the global quality of life (GQOL). Coefficients and level specific utility values obtained from a hybrid regression model for the Ethiopian population were used to compute utility values of each health state. Data was analyzed using SPSS version 23. Results The mean age of patients was 43.94 ± 11.72 years. The mean score for GQoL and visual analog scale was 59.32 ± 22.94 and 69.94 ± 20.36, respectively while the mean utility score was 0.8 ± 0.25. Predictors of GQoL were stage of cancer (AOR = 7.94; 95% CI: 1.83–34.54), cognitive functioning (AOR = 2.38; 95% CI: 1.32–4.31), pain (AOR = 7.99; 95% CI: 4.62–13.83), financial difficulties (AOR = 2.60; 95% CI: 1.56–4.35), and future perspective (AOR = 2.08; 95% CI: 1.24–3.49). Conclusions The overall GQoL of breast cancer patients was moderate. Targeted approaches to improve patients’ HRQoL should consider stage of cancer, cognitive functioning, pain, financial status and worries about the patient’s future health. This study also provides estimates of EQ-5D utility scores that can be used in economic evaluations.
Collapse
Affiliation(s)
- Selamawit Gebrehiwot Sibhat
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Zambia Street, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Zambia Street, Addis Ababa, Ethiopia
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | |
Collapse
|
27
|
Shah S, Abbas G, Hanif M, Anees-Ur-Rehman, Zaman M, Riaz N, Altaf A, Hassan SU, Saleem U, Shah A. Increased burden of disease and role of health economics: Asia-pacific region. Expert Rev Pharmacoecon Outcomes Res 2019; 19:517-528. [DOI: 10.1080/14737167.2019.1650643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shahid Shah
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ghulam Abbas
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Hanif
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees-Ur-Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Penang, Malaysia
| | - Muhammad Zaman
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Nabeel Riaz
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Arslan Altaf
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Shams Ul Hassan
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Usman Saleem
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Abid Shah
- Pediatric Medicine Department, Mukhtar Ahmad Sheikh Hospital, Multan, Pakistan
| |
Collapse
|
28
|
Lima DLF, Saintrain MVL, Neri JR, Beck O, Malet P, Moizan JAH, Doucet J. Oral health complications in Brazilian and French diabetic older people: A comparative study. Arch Gerontol Geriatr 2019; 84:103905. [PMID: 31319368 DOI: 10.1016/j.archger.2019.103905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France. METHODS This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p < 0.05. RESULTS Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p < 0.001). Tooth brushing frequency differed significantly between the groups (p < 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p < 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003). CONCLUSION Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.
Collapse
Affiliation(s)
- Danilo L F Lima
- School of Dentistry, University of Fortaleza - UNIFOR, Fortaleza, Brazil; School of Dentistry, Christus University Center - UNICHISTUS, Fortaleza, Brazil
| | | | - Jiovanne R Neri
- School of Dentistry, University of Fortaleza - UNIFOR, Fortaleza, Brazil; School of Dentistry, Christus University Center - UNICHISTUS, Fortaleza, Brazil.
| | - Oscar Beck
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Pierre Malet
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Jean A H Moizan
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Jean Doucet
- Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, Rouen, France
| |
Collapse
|
29
|
Wondmagegn BY, Xiang J, Williams S, Pisaniello D, Bi P. What do we know about the healthcare costs of extreme heat exposure? A comprehensive literature review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:608-618. [PMID: 30677927 DOI: 10.1016/j.scitotenv.2018.11.479] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 05/04/2023]
Abstract
Exposure to extreme heat can lead to a range of heat-related illnesses, exacerbate pre-existing health conditions and cause increased demand on the healthcare system. A projected increase in temperature may lead to greater healthcare expenditure, however, at present the costs of heat-related healthcare utilization is under-researched. This study aims to review the literature on heat-related costs for the healthcare system with a focus on ED visits, hospitalization, and ambulance call-outs. PubMed, Scopus, and Embase were used to search relevant literature from database inception to December 2017 and limited to human studies and English language. After screening, a total of ten papers were identified for final inclusion. In general, the healthcare costs of heat extremes have been poorly investigated in developed countries and not reported in developing countries where the largest heat-vulnerable populations reside. Studies showed that exposure to extreme heat was causing a substantial economic burden on healthcare systems. Females, the elderly, low-income families, and ethnic minorities had the highest healthcare costs on a range of health services utilization. Although a few studies have estimated heat healthcare costs, none of them quantified the temperature-healthcare cost relationship. There is a need to systematically examine heat-attributable costs for the healthcare system in the context of climate change to better inform heat-related policy making, target interventions and resource allocation.
Collapse
Affiliation(s)
- Berhanu Y Wondmagegn
- School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide, South Australia 5000, Australia; College of Health and Medical Sciences, Haramaya University, Ethiopia, P.O. Box 138, Dire Dawa, Ethiopia.
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide, South Australia 5000, Australia.
| | - Susan Williams
- School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide, South Australia 5000, Australia.
| | - Dino Pisaniello
- School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide, South Australia 5000, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide, South Australia 5000, Australia.
| |
Collapse
|
30
|
Dabak SV, Pilasant S, Mehndiratta A, Downey LE, Cluzeau F, Chalkidou K, Luz ACG, Youngkong S, Teerawattananon Y. Budgeting for a billion: applying health technology assessment (HTA) for universal health coverage in India. Health Res Policy Syst 2018; 16:115. [PMID: 30486827 PMCID: PMC6262968 DOI: 10.1186/s12961-018-0378-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country. METHODS A paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25-27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey. RESULTS Three quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations. CONCLUSION The findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage in India.
Collapse
Affiliation(s)
| | - Songyot Pilasant
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Abha Mehndiratta
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Laura Emily Downey
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Francoise Cluzeau
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, United Kingdom
- Center for Global Development, London, United Kingdom
| | | | - Sitaporn Youngkong
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
- National Health Foundation, Bangkok, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore, Singapore
| |
Collapse
|
31
|
Zegeye EA, Reshad A, Bekele EA, Aurgessa B, Gella Z. The State of Health Technology Assessment in the Ethiopian Health Sector: Learning from Recent Policy Initiatives. Value Health Reg Issues 2018; 16:61-65. [PMID: 30195092 DOI: 10.1016/j.vhri.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Abstract
Health technology assessment (HTA) has previously been implemented only in a fragmented manner in the Ethiopian health sector decision-making cycle, and the sector has been hampered by limited institutional capacity and skilled human resources to inform evidence-based decision making. The country is in the midst of widescale implementation of a community-based health insurance scheme and is preparing for the launch of a social health insurance scheme. The country continues to face a limited financial resource envelope, undergoing an epidemiological transition, and is facing a much greater burden of noncommunicable diseases, for which the essential health benefit package, defined 12 years ago, may no longer be suitable. This has called for an in-depth review of the application of HTA in the context of the current health needs and institutional settings. To meet the increasing need for HTA, the Health Economics and Financing Analysis (HEFA) team was established within the Finance Resource Mobilization Department under the Ministry of Health. The HEFA team is tasked with spearheading the application of evidence-based health care decision making in Ethiopia by organizing available evidence, costing interventions, and defining effectiveness measures of the different health programs and then supporting policymakers at the national and regional levels. Improving and harmonizing the institutional approach to HTA, including staffing the HEFA team with the appropriate mix of expertise, and networking with relevant sector organizations will improve Ethiopia's ability to tackle the current health sector challenges as well as protect fledgling insurance schemes' progress toward universal health coverage.
Collapse
Affiliation(s)
- Elias Asfaw Zegeye
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
| | | | - Eyersualem Animut Bekele
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Belay Aurgessa
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Zenebech Gella
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| |
Collapse
|
32
|
Affiliation(s)
- Suguna Anbazhagan
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - A Surekha
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| |
Collapse
|
33
|
Bay V, Tabarsi P, Rezapour A, Marzban S, Zarei E. Cost of Tuberculosis Treatment: Evidence from Iran's Health System. Osong Public Health Res Perspect 2017; 8:351-357. [PMID: 29164047 PMCID: PMC5678196 DOI: 10.24171/j.phrp.2017.8.5.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/15/2017] [Accepted: 10/10/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran. METHODS In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district's health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider's perspective using an activity-based costing (ABC) method. RESULTS The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%). CONCLUSION Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.
Collapse
Affiliation(s)
- Vahid Bay
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Marzban
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Zarei
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
34
|
Abstract
Randomized controlled trials (RCTs) are the gold standard for measuring the safety and efficacy of drugs. However, they are being challenged by payers and health care providers since they are looking for real world evidence (RWE) to validate whether the new intervention provides similar safety and efficacy as reported in RCT data. RWE uses real world data (RWD) to generate insight, foresight, and explorative findings on diseases, products, and patient populations. There are varied sources of RWD such as administrative data, large pragmatic trials, registries, electronic health records, and health surveys. RWE approaches are increasingly becoming the normal practice in developed countries to bring a product to the healthcare market and to ensure its significance in clinical practice. The Indian healthcare sector is growing at a brisk pace and is grasping up with the principles of health economics and outcome research, thereby exhibiting the value of real-world insights in healthcare decision. India has taken a step toward RWE by developing a framework to assist health care providers in harmonizing RWD for economic, clinical, and humanistic outcome.
Collapse
Affiliation(s)
- Amit Dang
- MarksMan Healthcare Solutions LLP, Kopar Khairane, Navi Mumbai, Maharashtra, India
| | - B N Vallish
- Department of Pharmacology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| |
Collapse
|