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Alami-Yadri A, Ghanname I, Cherkani-Hassani A, Zagmout A, Benitez-Rexach AM, Bousouf A, Rahhali K. The analysis of Asthma Control using Markov Models: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). J Asthma 2024:1-15. [PMID: 38814856 DOI: 10.1080/02770903.2024.2360943] [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: 01/09/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities. Four hundred twenty-four asthma patients from three hospitals in Morocco were included in the study, spanning 42 months.A discrete-time homogeneous Markov model with three states and a single aperiodic recurrent class was used to model the asthma evolution, assuming the regularity of consultations. Results showed that controlled patients were more likely to remain in that state, with approximately 79 out of 100 patients expected to stay in optimal control in the long term.A discrete non-homogeneous time Markov Model with the stationarity criterion was used to examine the factors affecting patient states and transitions. Patients seen during the spring and summer seasons were more likely to move into a controlled state compared with those seen in the fall and winter seasons. Patients with dust allergies and obesity significantly impacted asthma exacerbation, with overweight patients more likely to transition into a controlled state.The study estimated the transition intensities matrix under certain conditions, assuming the regularity of patients. In the long term, the probability of an asthmatic patient being in a controlled state was approximately 0.8.Overall, this study provided insights into the probabilities and factors influencing asthma progression in Morocco. Dust allergy and obesity were identified as significant contributors to asthma exacerbation, emphasizing the need for effective management strategies.
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Affiliation(s)
- Amina Alami-Yadri
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
| | - Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomic - Faculty of Medicine and Pharmacy, Mohammed V University, Rabat - Morocco
| | - Abha Cherkani-Hassani
- Laboratory of Analytical Chemistry and Bromatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Zagmout
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca - Morocco
| | - Aida M Benitez-Rexach
- Independent Scholar-Practitioner and Educational Consultant in Health and Educational Psychology
| | - Abdellah Bousouf
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
| | - Khalid Rahhali
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
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Stolbrink M, Thomson H, Hadfield RM, Ozoh OB, Nantanda R, Jayasooriya S, Allwood B, Halpin DMG, Salvi S, de Oca MM, Mortimer K, Rylance S. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Glob Health 2022; 10:e1423-e1442. [PMID: 36113528 PMCID: PMC9638033 DOI: 10.1016/s2214-109x(22)00330-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs. METHODS A systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069. FINDINGS Of 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity. INTERPRETATION Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. FUNDING WHO and Wellcome Trust.
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Affiliation(s)
- Marie Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
| | | | - Ruth M Hadfield
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia; Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences Kampala, Kampala, Uganda
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; University of Sheffield, Sheffield, UK
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa; Tygerberg Hospital, Cape Town, South Africa
| | - David M G Halpin
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; University of Exeter Medical School, Exeter, UK
| | - Sundeep Salvi
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Maria Montes de Oca
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Universidad Central de Venezuela, Caracas, Venezuela; Centro Medico de Caracas Hospital, Caracas, Venezuela
| | - Kevin Mortimer
- The International Union Against Tuberculosis and Lung Disease, Paris, France; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarah Rylance
- Noncommunicable Disease Management Unit, WHO, Geneva, Switzerland
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Saleh S, El Harakeh A, Baroud M, Zeineddine N, Farah A, Sibai AM. Costs associated with management of non-communicable diseases in the Arab Region: a scoping review. J Glob Health 2018; 8:020410. [PMID: 30546867 PMCID: PMC6287209 DOI: 10.7189/jogh.08.020410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Global mortality rates resulting from non-communicable diseases (NCDs) are reaching alarming levels, especially in low- and middle-income countries, imposing a considerable burden on individuals and health systems as a whole. This scoping review aims at synthesizing the existing literature evaluating the cost associated with the management and treatment of major NCDs across all Arab countries; at evaluating the quality of these studies; and at identifying the gap in existing literature. METHODS A systematic search was conducted using Medline electronic database to retrieve articles evaluating costs associated with management of NCDs in Arab countries, published in English between January 2000 and April 2016. 55 studies met the eligibility criteria and were independently screened by two reviewers who extracted/calculated the following information: country, theme (management of NCD, treatment/medication, or procedure), study design, setting, population/sample size, publication year, year for cost data cost conversion (US$), costing approach, costing perspective, type of costs, source of information and quality evaluation using the Newcastle-Ottawa Scale (NOS). RESULTS The reviewed articles covered 16 countries in the Arab region. Most of the studies were observational with a retrospective or prospective design, with a relatively low to very low quality score. Our synthesis revealed that NCDs' management costs in the Arab region are high; however, there is a large variation in the methods used to quantify the costs of NCDs in these countries, making it difficult to conduct any type of comparisons. CONCLUSIONS The findings revealed that data on the direct costs of NCDs remains limited by the paucity of this type of evidence and the generally low quality of studies published in this area. There is a need for future studies, of improved and harmonized methodology, as such evidence is key for decision-makers and directs health care planning.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El Harakeh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maysa Baroud
- Refugee Research and Policy Program, Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon
| | - Najah Zeineddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Ghanname I, Chaker A, Cherkani Hassani A, Herrak L, Arnaul Ebongue S, Laine M, Rahhali K, Zoglat A, Benitez Rexach AM, Ahid S, Cherrah Y. Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). BMC Pulm Med 2018; 18:61. [PMID: 29699541 PMCID: PMC5921326 DOI: 10.1186/s12890-018-0624-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control. METHODS A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control. CONCLUSION The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.
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Affiliation(s)
- Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco. .,Faculty of Health Sciences, International University of Casablanca, Bouskoura, Morocco.
| | - Ahmed Chaker
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abha Cherkani Hassani
- Unit of training and research in Nutrition and Food Sciences, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Laila Herrak
- Department of Pneumology, Ibn Sina Hospital, Rabat, Morocco
| | | | - Mustapha Laine
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | - Khalid Rahhali
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abdelhak Zoglat
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Aida Maria Benitez Rexach
- Department of Languages, International University of Casablanca, Bouskoura, Morocco.,Doctoral Student in Psychology, Walden University, Minneapolis, USA
| | - Samir Ahid
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yahia Cherrah
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Ghanname I, Ahid S, Berrada G, Belaiche A, Hassar M, Cherrah Y. Factors influencing anti-asthmatic generic drug consumption in Morocco: 1999-2010. SPRINGERPLUS 2014; 3:192. [PMID: 24790832 PMCID: PMC4002999 DOI: 10.1186/2193-1801-3-192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/04/2014] [Indexed: 11/21/2022]
Abstract
Background The increasing availability of generic drugs (GD) resulted in a remarkable reduction in treatment costs that allowed a better access to health care.The aim of this study is to evaluate the share of anti-asthmatic generic drugs during the period 1999-2010 in Morocco and to look at the factors influencing generic development. Methods In this study, we used Moroccan sales data from IMS Health (Intercontinental Marketing Services). The consumption of the drugs was expressed in DDD/1000 inhabitants/day according to the WHO ATC/DDD methodology. Results Between 1999 and 2010, anti-asthmatic consumption increased from 3.91 to 14.43 DDD/1000 inhabitants/day. The market of anti-asthmatic generic drugs progressed from 1.83 (47%) to 2.18 (23%) DDD/1000 inhabitants/day from 1999 to 2010. In 2010, inhaled glucocorticosteroids ranked first (0.83 DDD/1000 inhabitants/day), followed by inhaled short acting beta agonists (0.73 DDD/1000 inhabitants/day). The number of brands went from 27 in 1999 to 34 in 2010, with a generic share increasing from 55.55% to 70.59%. The number of anti-asthmatic pharmaceutical preparations increased from 57 to 64 during the same period, of which 31 and 42 were generic preparations. In 2010, the total cost of anti-asthmatic dugs was about 22 million euro, the generics representing 14 million euro. Conclusion Despite the introduction of a compulsory insurance scheme called “AMO”, that allows a refund for 69.5% of anti-asthmatic specialties marketed in Morocco, anti-asthmatic generic drug consumption remains limited. The Moroccan market is still largely dominated by the originator drugs with still valid patents.
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Affiliation(s)
- Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Faculty of Medicine and Pharmacy of Rabat. Morocco, University Mohammed V -Souissi, Rabat, Morocco
| | - Samir Ahid
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Faculty of Medicine and Pharmacy of Rabat. Morocco, University Mohammed V -Souissi, Rabat, Morocco
| | - Ghizlane Berrada
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Faculty of Medicine and Pharmacy of Rabat. Morocco, University Mohammed V -Souissi, Rabat, Morocco
| | | | - Mohammed Hassar
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Faculty of Medicine and Pharmacy of Rabat. Morocco, University Mohammed V -Souissi, Rabat, Morocco
| | - Yahia Cherrah
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Faculty of Medicine and Pharmacy of Rabat. Morocco, University Mohammed V -Souissi, Rabat, Morocco
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