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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Shah K, Nakafeero J, Kadota JL, Wambi P, Nanyonga G, Kiconco E, Deus A, Sekadde MP, Nabukenya-Mudiope MG, Tukamuhebwa HA, Mupere E, Mohanty S, Cattamanchi A, Wobudeya E, Shete PB, Jaganath D. The socioeconomic burden of pediatric tuberculosis and role of child-sensitive social protection. BMC Public Health 2023; 23:2339. [PMID: 38007477 PMCID: PMC10675962 DOI: 10.1186/s12889-023-17084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/27/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Households of children with tuberculosis (TB) experience financial and social hardships, but TB-specific social protection initiatives primarily focus on adults. METHODS We conducted a single-arm, pilot study of multi-component supportive benefits for children with pulmonary TB in Kampala, Uganda. At diagnosis, participants received in-kind coverage of direct medical costs, a cash transfer, and patient navigation. Caregivers were surveyed before diagnosis and 2 months into TB treatment on social and financial challenges related to their child's illness, including estimated costs, loss of income and dissaving practices. RESULTS We included 368 children from 321 households. Pre-diagnosis, 80.1% of caregivers reported that their child's illness negatively impacted household finances, 44.1% of caregivers missed work, and 24% engaged in dissaving practices. Catastrophic costs (> 20% annual income) were experienced by 18.4% (95% CI 13.7-24.0) of households. School disruption was common (25.6%), and 28% of caregivers were concerned their child was falling behind in development. Two months post-diagnosis, 12 households (4.8%) reported being negatively affected by their child's TB disease (difference -75.2%, 95% CI -81.2 to -69.2, p < 0.001), with limited ongoing loss of income (1.6%) or dissavings practices (0.8%). Catastrophic costs occurred in one household (0.4%) at 2 months post-diagnosis. CONCLUSIONS Households face financial and social challenges prior to a child's TB diagnosis, and child-sensitive social protection support may mitigate ongoing burden.
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Affiliation(s)
- Kinari Shah
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | | | - Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - Peter Wambi
- Mulago National Referral Hospital, Kampala, Uganda
| | | | - Emma Kiconco
- Mulago National Referral Hospital, Kampala, Uganda
| | - Atwiine Deus
- Mulago National Referral Hospital, Kampala, Uganda
| | - Moorine P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | | | | | - Ezekiel Mupere
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Swomitra Mohanty
- Departments of Chemical Engineering and Materials Science Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, Orange, California, USA
| | | | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - Devan Jaganath
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA.
- Division of Pediatric Infectious Diseases, University of California, San Francisco, California, USA.
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Sánchez X, Leal G, Padilla A, Jimbo R. Medical cost of acute diarrhea in children in ambulatory care. PLoS One 2022; 17:e0279239. [PMID: 36525458 PMCID: PMC9757569 DOI: 10.1371/journal.pone.0279239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to estimate the direct medical cost per episode and the annual cost for acute diarrhea (AD) in children under five years of age in Ambulatory Care Centers of the Ministry of Public Health (MOPH) of Ecuador. METHODS A cost of illness study with a provider perspective was carried out through a micro-costing of health resources and valuated in international dollars. Medical consultations and laboratory tests were valued using the tariff framework of services for the National Health System and for the prescribed medications, a reported cost registry of pharmacy purchases made in the year of study was used. RESULTS A total of 332 electronic health records of children under five years of age were included in the analysis. Laboratory tests were performed on 37.95% (126/332), medications were prescribed to 93.67% (311/332) of the children, and antimicrobials were prescribed to 37.35% (124/332) of the children, representing an antibiotic prescription rate of 26.51% (88/332) and an antiparasitic prescription rate of 10.84% (36/332). The mean cost of the MOPH per child per episode of AD was US$45.24 (2019 dollars) (95% CI:43.71 to 46.76). CONCLUSION The total estimated cost of AD in children under five years of age for the MOPH in 2019 was about US$6,645,167.88 million (2019 dollars) (95% CI: 6,420,430.77 to 6,868,436.12). A high proportion of the direct medical cost of AD in children under five years of age in outpatient settings is due to unnecessary laboratory tests.
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Affiliation(s)
- Xavier Sánchez
- Centro de Investigación en Salud para América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Gerardine Leal
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Angel Padilla
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Ruth Jimbo
- Centro de Investigación en Salud para América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- * E-mail:
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da Penha JC, do Nascimento LA, de Sabino LMM, da Rocha Mendes ER, da Rocha SS, Roubert ESC, Lima FET, de Oliveira Melo RC, de Almeida PC, Melo ESJ, Barbosa LP. Effects of Educational Interventions on Maternal Self-efficacy and Childhood Diarrhea: A Randomized Clinical Trial. Matern Child Health J 2022; 26:1507-1515. [PMID: 35288818 DOI: 10.1007/s10995-022-03408-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Diarrhea still causes high morbidity and mortality in children under five, requiring constant interventions. Thus, the study aims to evaluate the effects of educational technologies on maternal self-efficacy to prevent childhood diarrhea. METHODS Randomized clinical trial carried out in Fortaleza, Ceará, Brazil, with four randomized groups of mothers of children under 5 years of age, as follows: control group (n = 61), group A (booklet, n = 60), group B (video, n = 60), and group AB (booklet and video, n = 60). From June to October 2015, data collection was carried out in three moments (the first in person and the others by telephone monitoring). RESULTS All groups improved their self-efficacy after the intervention, with higher scores in the group AB (booklet and video). A statistically significant association was found between the occurrence of diarrhea and maternal self-efficacy in groups A (booklet) (p = 0.023) and AB (booklet and video) (p = 0.042) at the second moment of data collection. From the second moment to the third moment, the risk of diarrhea decreased in group A, from 12.8 to 1.3, and in group AB, from 8.5 to 1.1. CONCLUSION The technologies used, isolated or combined, were effective in improving maternal self-efficacy and decreasing the occurrence of childhood diarrhea; therefore, they can be used by nurses as health education tools.
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Affiliation(s)
| | | | | | | | | | - Emilia Soares Chaves Roubert
- Department of Nursing, University of International Integration of African-Brazilian Lusophony, Redenção, Ceará, Brazil
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Sultana R, Luby SP, Gurley ES, Rimi NA, Swarna ST, Khan JAM, Nahar N, Ghosh PK, Howlader SR, Kabir H, Khan S, Jensen PKM. Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009439. [PMID: 34115764 PMCID: PMC8221788 DOI: 10.1371/journal.pntd.0009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods. The illness cost borne by households, known as out-of-pocket expenditure was 74% of the total health expenditure in Bangladesh in 2017. Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children. Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had ≤ 2 US$ dollar income per capita per day still remained unknown. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 2015 to July 2016 to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 (2,147 BDT) and non-severe diarrhea was US$ 6.36 (499 BDT). A single diarrheal episode substantially affects financial capability of the low-income urban community: a severe episode can cost 4.35 days (17%) and a non-severe episode can cost 1 day (4%) of income of a households. Preventing diarrhea preserves health and supports financial livelihoods.
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Affiliation(s)
- Rebeca Sultana
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Stephen P. Luby
- Stanford University, Stanford, California, United States of America
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Nazmun Nahar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Niyibitegeka F, Riewpaiboon A, Youngkong S, Thavorncharoensap M. Economic burden of childhood diarrhea in Burundi. Glob Health Res Policy 2021; 6:13. [PMID: 33845920 PMCID: PMC8042854 DOI: 10.1186/s41256-021-00194-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. METHODS The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. RESULTS One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. CONCLUSION Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
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Affiliation(s)
- Fulgence Niyibitegeka
- Master of Science Program in Social, Economic, and Administrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand.
| | - Sitaporn Youngkong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
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de Broucker G, Sim SY, Brenzel L, Gross M, Patenaude B, Constenla DO. Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2020; 38:1071-1094. [PMID: 32748334 PMCID: PMC7578143 DOI: 10.1007/s40273-020-00940-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. OBJECTIVE The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. DATA SOURCES Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies must (1) be peer reviewed, (2) be published in 2000-2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. LIMITATIONS We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1-75% of the household's monthly income or 10-83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a 'real-world' estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, 415 North Washington Street, Suite #530, Baltimore, MD, 21231, USA.
| | - So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna O Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- GlaxoSmithKline Plc, Panama City, Panama
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Baral R, Nonvignon J, Debellut F, Agyemang SA, Clark A, Pecenka C. Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates. BMC Public Health 2020; 20:619. [PMID: 32370763 PMCID: PMC7201538 DOI: 10.1186/s12889-020-08595-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. Methods The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME’s service delivery unit costs to explore input sensitivity on modelled cost estimates. Results We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 – $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 – $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 – $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 –$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson’s correlation coefficient = .75). Conclusion Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.
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Affiliation(s)
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.,Health Economics, Systems and Policy Research Group, University of Ghana, Legon, Accra, Ghana
| | | | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, London, UK
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Kodhiambo MO, Oyugi JO, Amugune BK. Modelling the household cost of paediatric malaria treatment in a rural county in Kenya: do non-user fee payments matter? A partial cost of illness analysis. BMJ Open 2020; 10:e033192. [PMID: 32205372 PMCID: PMC7103840 DOI: 10.1136/bmjopen-2019-033192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop an econometric model for the cost of treatment of paediatric malaria from a patient perspective in a resource scarce rural setting of Homa Bay County, Kenya. We sought to investigate the main contributors as well as the contribution of non-user fee payments to the total household cost of care. Costs were measured from a patient perspective. DESIGN The study was conducted as a health facility based cross sectional survey targeting paediatric patients. SETTING The study was conducted in 13 health facilities ranging from level II to level V in Homa Bay County which is in the Eastern shores of Lake Victoria, Kenya. This is a malaria endemic area. PARTICIPANTS We enrolled 254 inpatient children (139 males and 115 females) all of whom participated up to the end of this study. PRIMARY OUTCOME MEASURE The primary outcome measure was the cost of pediatric malaria care borne by the patient. This was measured by asking exiting caregivers to estimate the cost of various items contributing to their total expenditure on care seeking. RESULTS A total of 254 respondents who consented from 13 public government health facilities were interviewed. Age, number of days spent at the health facility, being treated at a level V facility, medical officer prescribing and seeking initial treatment from a retail shop were found significant predictors of cost. CONCLUSION Higher level health facilities in Homa Bay County, where the more specialised medical workers are stationed, are more costly hence barring the poorest from obtaining quality paediatric malaria care from here. Waiving user fees alone may not be sufficient to guarantee access to care by patients due to unofficial fees and non-user fees expenditures.
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Anderson JD, Muhib F, Rheingans R, Wierzba T. Heterogeneity in potential impact and cost-effectiveness of ETEC and Shigella vaccination in four sub-Saharan African countries. Vaccine X 2019; 3:100043. [PMID: 31687662 PMCID: PMC6819873 DOI: 10.1016/j.jvacx.2019.100043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
Diarrheal disease burden has become more heterogenous in low- and lower middle-income countries as access to clean water, sanitation and health care has increased in wealthier urban populations. Enterotoxigenic Escherichia coli (ETEC) and Shigella are among the top five causes of diarrheal mortality in children living in sub-Saharan Africa. Here, we explored how accounting for subnational and economic heterogeneity in ETEC and Shigella disease burden affects projected vaccine impact and cost-effectiveness of standalone ETEC and Shigella vaccines during the first decade after introduction in four sub-Saharan African countries. We developed dynamic models for provincial areas and socioeconomic subpopulations of children in the Democratic Republic of Congo (DRC), Kenya, Zambia, and Zimbabwe. We estimated deaths and morbidity due to ETEC and Shigella diarrhea plus additional deaths from other infectious diseases attributable to ETEC- and Shigella-induced stunting. We analyzed cost-effectiveness using Incremental Cost-Effectiveness Ratios (ICERs) with Disability-Adjusted Life Years (DALYs) and Moderate-and-Severe Diarrheal episodes (MSD) averted as denominators. Other infectious disease deaths due to induced stunting accounted for 9-28% and 9-32% of the total provincial level ETEC and Shigella disease burden, respectively, across these four countries from years 2025 to 2034. Our results indicated that the lowest and most cost-effective provincial DALYs averted ICERs were below $600 and $500/DALY averted for ETEC and Shigella vaccination, respectively in Zimbabwe. ICERs were the highest in Zambia and Kenya, where all provincial ICERs where above $2000/DALY. The highest national and provincial MSD averted ICERs were in DRC, while the lowest were in Kenya and Zimbabwe. Vaccinations were most cost-effective in averting DALYs in lower wealth subpopulations living in the highest burden provincial areas. Our approach focused on subnational heterogeneity in ETEC and Shigella burden and vaccination access found that impact and cost-effectiveness were more favorable if vaccinations reach the most vulnerable children in underserved provinces.
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Affiliation(s)
- John D Anderson
- Goodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USA
| | - Farzana Muhib
- PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USA
| | - Richard Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USA
| | - Thomas Wierzba
- PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USA
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11
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Anderson JD, Bagamian KH, Muhib F, Baral R, Laytner LA, Amaya M, Wierzba T, Rheingans R. Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries. Vaccine X 2019; 2:100024. [PMID: 31384741 PMCID: PMC6668229 DOI: 10.1016/j.jvacx.2019.100024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022] Open
Abstract
While diarrhea mortality in children has declined over the last two decades, there has been a slower decline in diarrheal episodes. Repeated diarrheal episodes are associated with childhood stunting, which leads to increased mortality risk from infectious diseases. Vaccine candidates are under development for enterotoxigenic Escherichia coli [ETEC] and Shigella, important enteric pathogens in children in low income countries. These future vaccines could significantly reduce diarrheal burden, prevent ETEC- and Shigella-induced stunting, and stunting-associated mortality. We developed a cost-effectiveness model for two putative standalone ETEC and Shigella vaccine candidates to evaluate vaccine impact on mortality, morbidity, stunting, and stunting-associated deaths from other infectious diseases. We modeled impact over the first ten years after vaccine introduction in children under five years old living in 79 low and low-middle income countries. ETEC and Shigella diarrhea would cause an estimated 239,300 [95% UL: 179,700-309,800] and 340,300 [256,500-440,800] child deaths, respectively, from years 2025 to 2034. Most of these deaths would occur in AFRO countries. ETEC and Shigella moderate-to-severe diarrheal episodes would result in over 13.7 [8.4-19.0] and 21.4 [13.1-29.8] million stunted children, respectively. Introducing ETEC or Shigella vaccine each with 60% efficacy could prevent 92,000 [61,000-129,000] ETEC and 126,600 [84,000-179,000] Shigella direct deaths and 21,400 [11,300-34,800] ETEC- and 34,200 [18,000-56,000] Shigella-induced stunting deaths. ETEC ICERs ranged from $2172/DALY [1457-4369] in AFRO to $19,172/DALY [12,665-39,503] in EURO. Shigella ICERs ranged from $952/DALY [632-2001] in EMRO to $640,316/DALY [434,311-1,297,192] in EURO. Limitations of this analysis include uncertainty of vaccine efficacy, duration of protection, and vaccine price. Inclusion of other infectious disease mortality due to stunting provides a more accurate assessment of total ETEC and Shigella disease burden and increased the projected impact and cost-effectiveness of vaccination. Introducing vaccines only in high burden countries and regions could substantially reduce cost without substantially reducing impact.
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Affiliation(s)
- John D Anderson
- Goodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USA
- Emerging Pathogens Institute, P.O. Box 100009, 2055 Mowry Road, Gainesville, FL 32610, USA
| | - Karoun H Bagamian
- Department of Environmental and Global Health, University of Florida, Gainesville, FL 32603, USA
- Bagamian Scientific Consulting, 978 SW 2Ave., Gainesville, FL 32601, USA
| | - Farzana Muhib
- PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USA
| | - Ranju Baral
- PATH, 201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Lindsey A Laytner
- Emerging Pathogens Institute, P.O. Box 100009, 2055 Mowry Road, Gainesville, FL 32610, USA
- Department of Environmental and Global Health, University of Florida, Gainesville, FL 32603, USA
| | - Mirna Amaya
- Emerging Pathogens Institute, P.O. Box 100009, 2055 Mowry Road, Gainesville, FL 32610, USA
- Department of Environmental and Global Health, University of Florida, Gainesville, FL 32603, USA
| | - Thomas Wierzba
- PATH, 455 Massachusetts Ave. NW, Suite 1000, Washington, DC 20001, USA
| | - Richard Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, 222 Living Learning Center, 305 Bodenheimer Drive, Boone, NC 28608, USA
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12
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Zimmermann M, Kotloff K, Nasrin D, Roose A, Levine MM, Rheingans R, Farag T, Walker D, Pecenka C. Household Costs of Diarrhea by Etiology in 7 Countries, The Global Enterics Mulitcenter Study (GEMS). Open Forum Infect Dis 2019; 6:ofz150. [PMID: 31049364 PMCID: PMC6484153 DOI: 10.1093/ofid/ofz150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/29/2019] [Indexed: 11/15/2022] Open
Abstract
Background Although there are many overlapping features, pediatric diarrheal diseases can vary in severity, duration, clinical manifestations, and sequelae according to the causal pathogen, which in turn can impact the economic burden on patients and their families. We aimed to evaluate the household costs of diarrheal disease by pathogen in 7 countries. Methods We analyzed data from the Global Enteric Multicenter Study (GEMS), a prospective, age-stratified, matched case–control study of moderate to severe diarrheal disease among children aged 0–59 months in 7 low-income countries; 4 in Africa (Kenya, Mali, Mozambique, The Gambia) and 3 in Asia (Bangladesh, India, Pakistan). Demographic, epidemiological, economic, and clinical data were collected, and a stool sample was obtained for microbiological analysis at enrollment. We used a multivariate generalized linear model to assess the effect of rotavirus, Cryptosporidium, heat-stable toxin (ST)–producing enterotoxigenic Escherichia coli (ETEC [ST only or LT plus ST]), Shigella, Campylobacter jejuni, norovirus GII, Vibrio cholerae O1, age, gender, in/outpatient, and country on total costs to the patient/family. Results Household out-of-pocket costs were higher in Mali than any other country. Within countries, household cost differences between pathogens were minimal and not statistically significantly different. Conclusions We found no significant differences in household costs by pathogen. Despite data limitations, understanding pathogen-specific household costs (or lack thereof) is useful, as decision-makers could consider broader illness cost information and its relevance to a particular pathogen’s economic burden and contribution to poverty when deciding which pathogens to target for interventions.
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Affiliation(s)
| | - Karen Kotloff
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anna Roose
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Myron M Levine
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Tamar Farag
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Damian Walker
- The Bill and Melinda Gates Foundation, Seattle, Washington
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Guzman-Otazo J, Gonzales-Siles L, Poma V, Bengtsson-Palme J, Thorell K, Flach CF, Iñiguez V, Sjöling Å. Diarrheal bacterial pathogens and multi-resistant enterobacteria in the Choqueyapu River in La Paz, Bolivia. PLoS One 2019; 14:e0210735. [PMID: 30640938 PMCID: PMC6331111 DOI: 10.1371/journal.pone.0210735] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022] Open
Abstract
Water borne diarrheal pathogens might accumulate in river water and cause contamination of drinking and irrigation water. The La Paz River basin, including the Choqueyapu River, flows through La Paz city in Bolivia where it is receiving sewage, and residues from inhabitants, hospitals, and industry. Using quantitative real-time PCR (qPCR), we determined the quantity and occurrence of diarrheagenic Escherichia coli (DEC), Salmonella enterica, Klebsiella pneumoniae, Shigella spp. and total enterobacteria in river water, downstream agricultural soil, and irrigated crops, during one year of sampling. The most abundant and frequently detected genes were gapA and eltB, indicating presence of enterobacteria and enterotoxigenic E. coli (ETEC) carrying the heat labile toxin, respectively. Pathogen levels in the samples were significantly positively associated with high water conductivity and low water temperature. In addition, a set of bacterial isolates from water, soil and crops were analyzed by PCR for presence of the genes blaCTX-M, blaKPC, blaNDM, blaVIM and blaOXA-48. Four isolates were found to be positive for blaCTX-M genes and whole genome sequencing identified them as E. coli and one Enterobacter cloacae. The E. coli isolates belonged to the emerging, globally disseminated, multi-resistant E. coli lineages ST648, ST410 and ST162. The results indicate not only a high potential risk of transmission of diarrheal diseases by the consumption of contaminated water and vegetables but also the possibility of antibiotic resistance transfer from the environment to the community.
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Affiliation(s)
- Jessica Guzman-Otazo
- Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, La Paz, Bolivia
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Lucia Gonzales-Siles
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Violeta Poma
- Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Johan Bengtsson-Palme
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe) at the University of Gothenburg, Gothenburg, Sweden
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kaisa Thorell
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe) at the University of Gothenburg, Gothenburg, Sweden
| | - Volga Iñiguez
- Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Åsa Sjöling
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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14
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Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladesh. Trop Med Infect Dis 2018; 4:tropicalmed4010005. [PMID: 30587776 PMCID: PMC6473641 DOI: 10.3390/tropicalmed4010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. METHODS This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. RESULTS The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). CONCLUSIONS The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.
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Teni FS, Gebresillassie BM, Birru EM, Belachew SA, Tefera YG, Wubishet BL, Tekleyes BH, Yimer BT. Costs incurred by outpatients at a university hospital in northwestern Ethiopia: a cross-sectional study. BMC Health Serv Res 2018; 18:842. [PMID: 30409194 PMCID: PMC6225699 DOI: 10.1186/s12913-018-3628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background Out-of-pocket expenditure constitutes high proportion of healthcare spending in low-income countries. It can affect patients’ adherence to treatments leading to serious health consequences. The objective of this study was to document costs incurred by patients visiting Gondar University Referral Hospital, in Gondar, northwestern Ethiopia. Methods An institution-based cross-sectional study was conducted among 346 outpatients at the hospital from 2nd to 20th of May 2016. Data collection took place through interviews with patients coming to the outpatient pharmacy after finishing their visits at the different departments in the hospital. Data were collected on socio-demographic information, cost incurred before and during hospital visit as well as ownership of household items. Results Among the 342 interviews included in the final analysis, a median total cost of 22.25 USD was incurred by patients. This constituted spending on solutions tried before hospital visit, direct medical, nonmedical and indirect costs. Among these, direct nonmedical and indirect costs constituted a large share. Medicine, transportation and waiting time during visit were major components of direct medical, nonmedical and indirect costs respectively. Total median cost was found to be predicted by residence, marital status and payment scheme used to pay for hospital services. Conclusions Outpatients visiting the hospital incurred significant costs for illnesses/conditions associated with their visit to the hospital, the main components being nonmedical and indirect costs. Residence, marital status and payment scheme, predicted median total cost. Direct nonmedical costs and indirect costs were found to be significant components associated to the spending and loss of earning by patients and their families in their trip to and from the hospital.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Befikadu Legesse Wubishet
- Research Center for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Bethelhem Hailu Tekleyes
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bilal Tessema Yimer
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Ianiro G, Rizzatti G, Plomer M, Lopetuso L, Scaldaferri F, Franceschi F, Cammarota G, Gasbarrini A. Bacillus clausii for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2018; 10:nu10081074. [PMID: 30103531 PMCID: PMC6116021 DOI: 10.3390/nu10081074] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
Acute diarrhea is a burdensome disease with potentially harmful consequences, especially in childhood. Despite its large use in clinical practice, the efficacy of the probiotic Bacillus clausii in treating acute childhood diarrhea remains unclear. Our objective was to systematically review the efficacy of Bacillus clausii in the treatment of acute childhood diarrhea. The following electronic databases were systematically searched up to October 2017: MEDLINE (via PubMed/OVID), EMBASE (via OVID), Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and ClinicalTrials.gov. Only randomized controlled trials were included. The overall effect for the meta-analysis was derived by using a random effects model. Six randomized controlled trials (1298 patients) met the eligibility criteria. Data arising from pooled analysis showed that Bacillus clausii significantly reduced the duration of diarrhea (mean difference = -9.12 h; 95% confidence interval [CI]: -16.49 to -1.75, p = 0.015), and the duration of hospitalization (mean difference = -0.85 days; 95% CI: -1.56 to -0.15, p = 0.017), compared with control. There was a trend of decreasing stool frequency after Bacillus clausii administration compared with the control group (mean difference = -0.19 diarrheal motions; 95% CI: -0.43 to -0.06, p = 0.14). Bacillus clausii may represent an effective therapeutic option in acute childhood diarrhea, with a good safety profile.
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Affiliation(s)
- Gianluca Ianiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Gianenrico Rizzatti
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Manuel Plomer
- Medical Affairs CHC Germany, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Loris Lopetuso
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Franco Scaldaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Francesco Franceschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Giovanni Cammarota
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
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Sarker AR, Sultana M, Mahumud RA, Ali N, Huda TM, Salim uzzaman M, Haider S, Rahman H, Islam Z, Khan JAM, Van Der Meer R, Morton A. Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective. Glob Health Res Policy 2018; 3:1. [PMID: 29318195 PMCID: PMC5755417 DOI: 10.1186/s41256-017-0056-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. METHODS This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. RESULTS The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. CONCLUSIONS Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir M Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - M. Salim uzzaman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sabbir Haider
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hafizur Rahman
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Nonvignon J, Atherly D, Pecenka C, Aikins M, Gazley L, Groman D, Narh CT, Armah G. Cost-effectiveness of rotavirus vaccination in Ghana: Examining impacts from 2012 to 2031. Vaccine 2017; 36:7215-7221. [PMID: 29223486 PMCID: PMC6238184 DOI: 10.1016/j.vaccine.2017.11.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/26/2022]
Abstract
Ghana is currently transitioning away from Gavi support. Thus, cost-effectiveness is crucial for improving health system efficiency. Rotavirus vaccination brings health and economic benefits to Ghana. Rotavirus vaccination is highly cost-effective in Ghana, even Gavi transition.
Background Diarrhea causes about 10% of all deaths in children under five years globally, with rotavirus causing about 40% of all diarrhea deaths. Ghana introduced rotavirus vaccination as part of routine immunization in 2012 and it has been shown to be effective in reducing disease burden in children under five years. Ghana’s transition from low to lower-middle income status in 2010 implies fewer resources from Gavi as well as other major global financing mechanisms. Ghana will soon bear the full cost of vaccines. The aim of this study was to estimate the health impact, costs and cost-effectiveness of rotavirus vaccination in Ghana from introduction and beyond the Gavi transition. Methods The TRIVAC model is used to estimate costs and effects of rotavirus vaccination from 2012 through 2031. Model inputs include demographics, disease burden, health system structure, health care utilization and costs as well as vaccine cost, coverage, and efficacy. Model inputs came from local data, the international literature and expert consultation. Costs were examined from the health system and societal perspectives. Results The results show that continued rotavirus vaccination could avert more than 2.2 million cases and 8900 deaths while saving US$6 to US$9 million in costs over a 20-year period. The net cost of vaccination program is approximately US$60 million over the same period. The societal cost per DALY averted is US$238 to US$332 with cost per case averted ranging from US$27 to US$38. The cost per death averted is approximately US$7000. Conclusion The analysis shows that continued rotavirus vaccination will be highly cost-effective, even for the period during which Ghana will assume responsibility for purchasing vaccines after transition from Gavi support.
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Affiliation(s)
| | | | | | - Moses Aikins
- School of Public Health, University of Ghana, Legon, Ghana
| | | | | | - Clement T Narh
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Hendrix N, Bar-Zeev N, Atherly D, Chikafa J, Mvula H, Wachepa R, Crampin AC, Mhango T, Mwansambo C, Heyderman RS, French N, Cunliffe NA, Pecenka C. The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system. BMJ Open 2017; 7:e017347. [PMID: 28871025 PMCID: PMC5589001 DOI: 10.1136/bmjopen-2017-017347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi. SETTING Data were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre. PARTICIPANTS Children under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients. RESULTS Total costs in 2014 US$ for rural inpatient, rural outpatient, urban inpatient and urban outpatient were $65.33, $8.89, $60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%. CONCLUSION This study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness.
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Affiliation(s)
- Nathaniel Hendrix
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
| | - Naor Bar-Zeev
- The Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, Merseyside, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Deborah Atherly
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | - Jean Chikafa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hazzie Mvula
- Karonga Prevention Study, Chilumba, Malawi
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Wachepa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Amelia C Crampin
- Karonga Prevention Study, Chilumba, Malawi
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Division of Infection & Immunity, University College London, London, UK
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, Merseyside, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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Ndir A, Diop A, Ka R, Faye PM, Dia-Badiane NM, Ndoye B, Astagneau P. Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae: clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar, Senegal. Antimicrob Resist Infect Control 2016; 5:13. [PMID: 27096085 PMCID: PMC4835833 DOI: 10.1186/s13756-016-0114-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/10/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-E) are of major concern in clinical practice because of limited therapeutic options effective to treat them. Published studies showed that ESBL-E, widely spread in Europe, United States or Asia; are also frequent in Africa. However, the impact of ESBL-E infections is yet to be adequately determined in Sub-Saharan African countries, particularly in Senegal. The aim of our study was to estimate the incidence rate of ESBL-E infections and to assess their clinical and economic impact in Senegal. METHODS Two retrospective cohort studies were conducted in patients hospitalized from April to October 2012. A classic retrospective cohort study comparing patients infected by an Enterobacteriaceae producer of ESBL (ESBL+) and patients infected by an Enterobacteriaceae non-producer of ESBL (ESBL-) was carried out for fatal outcomes. Besides, a retrospective parallel cohort study comparing infected patients by an ESBL+ and ESBL- versus uninfected patients was carried out for the excess LOS analyses. Multivariable regression analysis was performed to identify risk factors for fatal outcomes. A multistate model and a cost-of-illness analysis were used to estimate respectively the excess length of stay (LOS) attributable to ESBL production and costs associated. Cox proportional hazards models were used to assess the independent effect of ESBL+ and ESBL- infections on LOS. RESULTS The incidence rate of ESBL-E infections was 3 cases/1000 patient-days (95 % CI: 2.4-3.5 cases/1000 patient-days). Case fatality rate was higher in ESBL+ than in ESBL- infections (47.3 % versus 22.4 %, p = 0.0006). Multivariable analysis indicated that risk factors for fatal outcomes were the production of ESBL (OR = 5.7, 95 % CI: 3.2-29.6, p = 0.015) or being under mechanical ventilation (OR = 5.6, 95 % CI: 2.9-57.5, p = 0.030). Newborns and patients suffering from meningitidis or cancer were patients at-risk for fatal outcomes. ESBL production increased hospital LOS (+4 days) and reduced significantly the hazard of discharge after controlling for confounders (HR = 0.3, 95 % CI:0.2-0.4). The additional cost associated with ESBL-production of €100 is substantial given the lower-middle-income status of Senegal. CONCLUSION Our findings show an important clinical and economic impact of ESBL-E infections in Senegal and emphasize the need to implement adequate infection control measures to reduce their incidence rate. An antibiotic stewardship program is also crucial to preserve the effectiveness of our last-resort antibiotic drugs.
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Affiliation(s)
- Awa Ndir
- />PhD Program, Université Pierre Marie Curie, Paris, France
- />Institut Pasteur de Dakar, Epidemiology unit, Dakar, Senegal
- />Infection Control Africa NetworK, Cape Town, South Africa
| | - Amadou Diop
- />Hôpital pour Enfants Albert Royer, Dakar, Senegal
| | - Roughyatou Ka
- />Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | | | | | - Babacar Ndoye
- />Infection Control Africa NetworK, Cape Town, South Africa
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Ngabo F, Mvundura M, Gazley L, Gatera M, Rugambwa C, Kayonga E, Tuyishime Y, Niyibaho J, Mwenda JM, Donnen P, Lepage P, Binagwaho A, Atherly D. The Economic Burden Attributable to a Child's Inpatient Admission for Diarrheal Disease in Rwanda. PLoS One 2016; 11:e0149805. [PMID: 26901113 PMCID: PMC4764684 DOI: 10.1371/journal.pone.0149805] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
Abstract
Background Diarrhea is one of the leading causes of childhood morbidity and mortality. Hospitalization for diarrhea can pose a significant burden to health systems and households. The objective of this study was to estimate the economic burden attributable to hospitalization for diarrhea among children less than five years old in Rwanda. These data can be used by decision-makers to assess the impact of interventions that reduce diarrhea morbidity, including rotavirus vaccine introduction. Methods This was a prospective costing study where medical records and hospital bills for children admitted with diarrhea at three hospitals were collected to estimate resource use and costs. Hospital length of stay was calculated from medical records. Costs incurred during the hospitalization were abstracted from the hospital bills. Interviews with the child’s caregivers provided data to estimate household costs which included transport costs and lost income. The portion of medical costs borne by insurance and household were reported separately. Annual economic burden before and after rotavirus vaccine introduction was estimated by multiplying the reported number of diarrhea hospitalizations in public health centers and district hospitals by the estimated economic burden per hospitalization. All costs are presented in 2014 US$. Results Costs for 203 children were analyzed. Approximately 93% of the children had health insurance coverage. Average hospital length of stay was 5.3 ± 3.9 days. Average medical costs for each child for the illness resulting in a hospitalization were $44.22 ± $23.74 and the total economic burden was $101, of which 65% was borne by the household. For households in the lowest income quintile, the household costs were 110% of their monthly income. The annual economic burden to Rwanda attributable to diarrhea hospitalizations ranged from $1.3 million to $1.7 million before rotavirus vaccine introduction. Conclusion Households often bear the largest share of the economic burden attributable to diarrhea hospitalization and the burden can be substantial, especially for households in the lowest income quintile.
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Affiliation(s)
- Fidele Ngabo
- Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Mercy Mvundura
- PATH, Devices and Tools Global Program, Seattle 98121, Washington, United States of America
- * E-mail:
| | - Lauren Gazley
- PATH, Vaccine Access and Delivery Global Program, Seattle 98121, Washington, United States of America
| | - Maurice Gatera
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Celse Rugambwa
- World Health Organization, Rwanda Country Office, Kigali, Rwanda
| | - Eugene Kayonga
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Jeanne Niyibaho
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
| | - Jason M. Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Philippe Donnen
- Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium
| | - Philippe Lepage
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnes Binagwaho
- Ministry of Health, Kigali, Rwanda
- Harvard Medical School, Boston, Massachusetts, United States of America
- Geisel School of Medicine, Dartmouth, Hanover, New Hampshire, United States of America
| | - Deborah Atherly
- PATH, Vaccine Access and Delivery Global Program, Seattle 98121, Washington, United States of America
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Diop A, Atherly D, Faye A, Lamine Sall F, Clark AD, Nadiel L, Yade B, Ndiaye M, Fafa Cissé M, Ba M. Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis. Vaccine 2016; 33 Suppl 1:A119-25. [PMID: 25919151 DOI: 10.1016/j.vaccine.2014.12.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Rotavirus is the leading cause of acute severe diarrhea among children under 5 globally and one of the leading causes of death attributable to diarrhea. Among African children hospitalized with diarrhea, 38% of the cases are due to rotavirus. In Senegal, rotavirus deaths are estimated to represent 5.4% of all deaths among children under 5. Along with the substantial disease burden, there is a growing awareness of the economic burden created by diarrheal disease. This analysis aims to provide policymakers with more consistent and reliable economic evidence to support the decision-making process about the introduction and maintenance of a rotavirus vaccine program. METHODS The study was conducted using the processes and tools first established by the Pan American Health Organization's ProVac Initiative in the Latin American region. TRIVAC version 2.0, an Excel-based model, was used to perform the analysis. The costs and health outcomes were calculated for 20 successive birth cohorts (2014-2033). Model inputs were gathered from local, national, and international sources with the guidance of a Senegalese group of experts including local pediatricians, personnel from the Ministry of Health and the World Health Organization, as well as disease-surveillance and laboratory specialists. RESULTS The cost per disability-adjusted life-year (DALY) averted, discounted at 3%, is US$ 92 from the health care provider perspective and US$ 73 from the societal perspective. For the 20 cohorts, the vaccine is projected to prevent more than 2 million cases of rotavirus and to avert more than 8500 deaths. The proportion of rotavirus deaths averted is estimated to be 42%. For 20 cohorts, the discounted net costs of the program were estimated to be US$ 17.6 million from the healthcare provider perspective and US$ 13.8 million from the societal perspective. CONCLUSION From both perspectives, introducing the rotavirus vaccine is highly cost-effective compared to no vaccination. The results are consistent with those found in many African countries. The ProVac process and tools contributed to a collaborative, country-led process in Senegal that provides a platform for gathering and reporting evidence for vaccine decision-making.
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Affiliation(s)
- Abdou Diop
- Independent Consultant for PATH, Dakar, Senegal
| | | | | | | | - Andrew D Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Moussa Fafa Cissé
- Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal
| | - Mamadou Ba
- Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal
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Burke RM, Smith ER, Dahl RM, Rebolledo PA, Calderón MDC, Cañipa B, Chavez E, Pinto R, Tamayo L, Terán C, Veizaga A, Zumaran R, Iñiguez V, Leon JS. The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden. BMC Public Health 2014; 14:642. [PMID: 24962128 PMCID: PMC4094680 DOI: 10.1186/1471-2458-14-642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 05/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). METHODS From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model). RESULTS We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). CONCLUSIONS Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.
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Affiliation(s)
- Rachel M Burke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Scharf RJ, Deboer MD, Guerrant RL. Recent advances in understanding the long-term sequelae of childhood infectious diarrhea. Curr Infect Dis Rep 2014; 16:408. [PMID: 24819871 DOI: 10.1007/s11908-014-0408-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Worldwide, early childhood infectious diarrhea continues to be a significant concern. Diarrheal illness affects the world's youngest and most vulnerable citizens disproportionately. Estimates are that over 70 % of deaths from diarrhea occur in people younger than 24 months of age. Diarrhea and environmental enteropathy have been associated with growth failure and stunting. In addition, the burden of enteric disease also leads to cognitive and academic losses, thus resulting in loss of human capital and economic productivity. While considerable progress has been made on preventing and treating childhood diarrheal illness, the mortality and morbidity still remain unacceptably high. This paper reviews recent (mainly from 2013) publications surrounding the global burden of childhood diarrhea and the implications for long-term sequelae.
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Affiliation(s)
- Rebecca J Scharf
- Center for Global Health, Departments of Pediatrics and Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA,
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