1
|
Gheinali Z, Moshiri E, Ebrahimi Tavani M, Haghi M, Gharibi F. Catastrophic health expenditures in hospitalized patients with delta variant of COVID-19: A cross-sectional study. Health Promot Perspect 2023; 13:68-76. [PMID: 37309437 PMCID: PMC10257567 DOI: 10.34172/hpp.2023.09] [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: 08/21/2022] [Accepted: 02/05/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health expenditures (CHE) and it's affecting factors in hospitalized patients with delta variant of COVID-19. Methods: In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE. Results: On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household's non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (P<0.05). Conclusion: The incidence of CHE in hospitalized COVID-19 patients was undesirable, which may be due to geographical, economical, and occupational inequalities apart from the factors related to the severity of the disease. So, health policymakers should pay attention to the provision of proper financial risk protection policies to make the health insurance system more efficient and appropriate.
Collapse
Affiliation(s)
- Zahra Gheinali
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Masoumeh Ebrahimi Tavani
- Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health & Medical Education, Tehran, Iran
| | - Mehdi Haghi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farid Gharibi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| |
Collapse
|
2
|
Khabir Y, Khan M, Iqbal U. The application of extended reality in cardiac surgery: potential implications for low- and middle-income countries. Int J Surg 2023; 109:41-42. [PMID: 36799788 PMCID: PMC10389573 DOI: 10.1097/js9.0000000000000082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Yumna Khabir
- Department of Medicine, Dow University of Health Sciences, Karachi, Sindh Province, Pakistan
| | | | | |
Collapse
|
3
|
Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran. Int J Equity Health 2022; 21:188. [PMID: 36581933 PMCID: PMC9798561 DOI: 10.1186/s12939-022-01791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/13/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran. METHOD The "budget share" and "capacity to pay" approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules. RESULTS The results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach. CONCLUSIONS Assessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship.
Collapse
|
4
|
Adeniji FIP, Lawanson AO, Osungbade KO. The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria. PLoS One 2022; 17:e0271568. [PMID: 35849602 PMCID: PMC9292125 DOI: 10.1371/journal.pone.0271568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
Methods
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Results
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26–0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24–0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18–0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003–0.25, p = <0.001) and having 3–4 household members (AOR: 0.30, CI: 0.15–0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
Conclusion
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
Collapse
Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Akanni Olayinka Lawanson
- Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria
| | - Kayode Omoniyi Osungbade
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
5
|
Jung H, Lee KS. What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:525-541. [PMID: 35285001 DOI: 10.1007/s40258-022-00727-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The United Nations set a goal for universal health coverage in all countries by 2030 and selected the catastrophic health expenditure (CHE) indicator as an assessment tool for this goal. Many countries have strived to reduce household CHE. However, no study has compared countries whose policies have had a remarkable effect on decreasing CHE. Therefore, the purpose of this systematic literature review is to find appropriate methods for measuring CHE that can help us to analyze the impact of health policies and identify countries whose health policies are most effective in reducing CHE. METHOD PubMed and Web of Science were searched. Studies that measured the incidence or intensity of CHE in multiple years were included. Two independent reviewers screened the literature, extracted the data, and analyzed the studies selected. Thirty-eight studies met the inclusion criteria for the review. We classified the selected research papers to random sampling and quasi-experimental studies. RESULTS We graphically presented the results of CHE incidence and intensity rates reported in the collected papers as a time series data set. Since most studies did not use sample weights, it was not easy to confirm whether the time series changes of CHE are significant. Therefore, we could find only two countries that had policy effects. Both countries established policies that focus on the poor. CONCLUSION There are so many studies that analyze CHE, but policies that are effective in reducing CHE are unknown. This study uses a systematic literature review methodology to determine effective policies by comparing CHE time series trends among countries. As a policy implication, it was found that because CHE is defined as the ratio of the ability to pay to medical expenses, a policy of differential medical expenses that is based on income level is effective.
Collapse
Affiliation(s)
- HyunWoo Jung
- Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Changjo Hall, Room Number 419, Yonseidaegil 1, Gangwon-do, Wonju, South Korea
| | - Kwang-Soo Lee
- Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Changjo Hall, Room Number 419, Yonseidaegil 1, Gangwon-do, Wonju, South Korea.
| |
Collapse
|
6
|
Ke C, Narayan KMV, Chan JCN, Jha P, Shah BR. Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol 2022; 18:413-432. [PMID: 35508700 PMCID: PMC9067000 DOI: 10.1038/s41574-022-00669-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.
Collapse
Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Liu K, Liu W, Frank R, Lu C. Assessing the Long-Term Effects of Basic Medical Insurance on Catastrophic Health Spending in China. Health Policy Plan 2022; 37:747-759. [PMID: 35238921 DOI: 10.1093/heapol/czac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Many developing countries have implemented social health insurance programs to protect their citizens against the financial risks of seeking healthcare. While many studies have explored how individual insurance enrollments affect catastrophic health spending (CHS) in the short term, there is a lack of evidence on the long-term macro-level effects of social health insurance on CHS in low- and middle-income countries. This study examines the long-term effects of Basic Medical Insurance (BMI) on individual CHS in China, a middle-income country that has witnessed one of the highest worldwide increases in CHS rates despite its remarkable achievement of universal health insurance coverage. Specifically, we used existing longitudinal data from 1989 to 2015, therein assessing BMI policy effects by constructing two macro-level indicators, including the year of BMI presence at the prefectural level and number of years relative to BMI introduction. We employed a three-level difference-in-differences approach for the estimation. There were two main findings. First, BMI policy did not significantly reduce the probability of incurring CHS for BMI enrollees over time. Years after BMI was introduced, the policy even predicted a significant increase in the probability of incurring CHS for individuals who shifted their enrollments from traditional insurance to BMI. Second, BMI policy had spillover effects on the increase in the probability of incurring CHS for non-BMI individuals a few years after its inception. We believe there are three possible explanations for these findings: (1) shrinking BMI service coverage compared to pre-existing government-funded insurance schemes, (2) a profit-driven hospital reform that induces the overuse of expensive medicines and diagnostic tests, and (3) the absence of strategic purchasing among local BMI agencies. We also discuss how relevant policy interventions may alleviate insurance-driven financial risks.
Collapse
Affiliation(s)
- Kai Liu
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Wenting Liu
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Richard Frank
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Ke J, Chen Y, Wang X, Wu Z, Zhang Q, Lian Y, Chen F. Machine learning-based in-hospital mortality prediction models for patients with acute coronary syndrome. Am J Emerg Med 2022; 53:127-134. [PMID: 35033770 DOI: 10.1016/j.ajem.2021.12.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models. METHODS The data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model. RESULTS A total of 6482 ACS patients were included in the study, and the in-hospital mortality rate was 1.88%. Multivariate logistic regression analysis found that age, NSTEMI, Killip III, Killip IV, and levels of D-dimer, cardiac troponin I, CK, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-density lipoprotein (HDL) cholesterol, and Stains were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.884, 0.918, 0.913, and 0.896, respectively. Feature importance evaluation found that NT-proBNP, D-dimer, and Killip were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model. CONCLUSIONS The predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, D-dimer, Killip, cTnI, and LDH as this may improve the clinical outcomes of ACS patients.
Collapse
Affiliation(s)
- Jun Ke
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai 201203, China
| | - Xiaoping Wang
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Zhiyong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China
| | - Qiongyao Zhang
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Yangpeng Lian
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Feng Chen
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China.
| |
Collapse
|
9
|
Soofi M, Arab‐Zozani M, Kazemi‐Karyani A, Karamimatin B, Najafi F, Ameri H. Can Health Insurance Protect Against Catastrophic Health Expenditures in Iran? A Systematic Review and Meta‐Analysis. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
10
|
Jiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban-Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open 2021; 11:e047699. [PMID: 34667000 PMCID: PMC8527163 DOI: 10.1136/bmjopen-2020-047699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is to explore the perceived financial risk protection effect of the Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI. DESIGN It is a cross-sectional survey. PARTICIPANTS This mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews. PRIMARY AND SECONDARY OUTCOME MEASURES A multivariate logistic regression analysis is adopted to identify factors influencing respondents' perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective. RESULTS Overall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price. CONCLUSIONS This exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.
Collapse
Affiliation(s)
- Huan Jiang
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of health management, Shcool of public health, Nantong university, Nantong, Jiangsu,China
| | - Guomei Tian
- Fourth affiliate hospital of Harbin Medical University, Harbin, Heilongjiang,China
| | - Zihua Zhao
- Scientific Research Department, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ding Ding
- Department of Social Medicine, Dalian Medical University, Dalian, China
| | - Mei Yin
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
| |
Collapse
|
11
|
Irham A, Umar H, Adam FMS, Mappangara I, Bakri S, Halim R, Zainuddin A. Concordance between Triglyceride Glucose Index and Admission Insulin Resistance Index in Non-diabetic Subjects of Acute Coronary Syndrome. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Acute coronary syndrome (ACS) is the leading cause of death in the world and is closely related to insulin resistance (IR). The examination of the triglyceride glucose (TyG) Index and admission IR index (AIRI) can be an alternative examination to assess IR.
AIM: The aim of the study was to analyze the concordance between the TyG index and AIRI in assessing IR in nondiabetic subjects of ACS.
METHODS: This study was a cross-sectional study using secondary data from ACS patient medical records in Wahidin Sudirohusodo Hospital Makassar from September 2020 until April 2021. An examination of RBG, TyG, and fasting insulin was performed. The statistical test results were considered significant if the p < 0.05.
RESULTS: This study included 67 subjects, of which 54 were male and 13 were female, there were 24 people aged <50 years, 43 people aged 50 years old, with a mean of 55.15 ± 12.71 years, a diagnosis of ST-elevation myocardial infarction (STEMI) 25 people, non STEMI 34 people and unstable angina pectoris 8 people, p < 0.05. The receiver operating characteristic curve showed that the cut-off value of the TyG index in predicting AIRI was 3141, with a sensitivity of 88.98% and specificity of 59.09%. The OR value revealed that subjects with a TyG index of >9.06 indicated an 11-time greater risk for IR than subjects with a TyG index ≤9.06.
CONCLUSIONS: There was a significant concordance between the TyG index and the AIRI in non-diabetic acute coronary syndrome patient.
Collapse
|
12
|
Huo Y, Van de Werf F, Han Y, Rossello X, Pocock SJ, Chin CT, Lee SWL, Li Y, Jiang J, Vega AM, Medina J, Bueno H. Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia. Am J Cardiovasc Drugs 2021; 21:471-482. [PMID: 33537947 PMCID: PMC8263456 DOI: 10.1007/s40256-020-00447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information is lacking on long-term management of patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). OBJECTIVES Our objectives were to describe antithrombotic management patterns and outcomes in patients with ACS with varying renal function from the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients; NCT01171404) and EPICOR Asia (NCT01361386) studies. METHODS EPICOR and EPICOR Asia were prospective observational studies of patients who survived hospitalization for ACS and were enrolled at discharge in 28 countries across Europe, Latin America, and Asia. The studies were conducted from 2010 to 2013 and from 2011 to 2014, respectively. This analysis evaluated patient characteristics and oral antithrombotic management patterns and outcomes up to 2 years post-discharge according to admission eGFR: ≥ 90, 60-89, 30-59, or < 30 mL/min/1.73 m2. RESULTS Among 22,380 patients with available data, eGFR < 60 mL/min/1.73 m2 was observed in 16.7%. Patients with poorer renal function were older, were at greater cardiovascular risk, and had more prior cardiovascular disease and bleeding. Patients with CKD underwent fewer cardiovascular interventions and had more in-hospital cardiovascular and bleeding events. Dual antiplatelet therapy was less likely at discharge in patients with eGFR < 30 (82.3%) than in those with ≥ 90 (91.3%) mL/min/1.73 m2 and declined more sharply during follow-up in patients with low eGFR (p < 0.0001). An adjusted proportional hazards model showed that patients with lower eGFR levels had a higher risk of cardiovascular events and bleeding. CONCLUSIONS The presence of CKD in patients with ACS was associated with less aggressive cardiovascular management and an increased risk of cardiovascular events.
Collapse
Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China.
| | | | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Yi Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China
| | | | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
13
|
Bhoo-Pathy N, Subramaniam S, Khalil S, Kimman M, Kong YC, Ng CW, Bustamam RS, Yip CH. Out-of-Pocket Costs of Complementary Medicine Following Cancer and the Financial Impact in a Setting With Universal Health Coverage: Findings From a Prospective Cohort Study. JCO Oncol Pract 2021; 17:e1592-e1602. [PMID: 34077232 DOI: 10.1200/op.20.01052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine household spending patterns on complementary medicine following cancer and the financial impact in a setting with universal health coverage. METHODS Country-specific data from a multinational prospective cohort study, Association of Southeast Asian Nations Costs in Oncology Study, comprising 1,249 cancer survivors were included. Household costs of complementary medicine (healthcare practices or products that are not considered as part of conventional medicine) throughout the first year after cancer diagnosis were measured using cost diaries. Study outcomes comprised (1) shares of household expenditures on complementary medicine from total out-of-pocket costs and health costs that were respectively incurred in relation to cancer, (2) incidence of financial catastrophe (out-of-pocket costs related to cancer ≥ 30% of annual household income), and (3) economic hardship (inability to pay for essential household items or services). RESULTS One third of patients reported out-of-pocket household expenditures on complementary medicine in the immediate year after cancer diagnosis, accounting to 20% of the total out-of-pocket costs and 35% of the health costs. Risk of financial catastrophe was higher in households reporting out-of-pocket expenditures on complementary medicine (adjusted odds ratio: 1.39 [95% CI, 1.05 to 1.86]). Corresponding odds ratio within patients from low-income households showed that they were substantially more vulnerable: 2.28 (95% CI, 1.41 to 3.68). Expenditures on complementary medicine were, however, not associated with economic hardship in the immediate year after cancer diagnosis. CONCLUSION In settings with universal health coverage, integration of subsidized evidence-based complementary medicine into mainstream cancer care may alleviate catastrophic expenditures. However, this must go hand in hand with interventions to reduce the use of nonevidence-based complementary therapies following cancer.
Collapse
Affiliation(s)
- Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shridevi Subramaniam
- Centre of Clinical Epidemiology, Institute of Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Sadia Khalil
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Yek-Ching Kong
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustamam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
14
|
Peiris D, Ghosh A, Manne-Goehler J, Jaacks LM, Theilmann M, Marcus ME, Zhumadilov Z, Tsabedze L, Supiyev A, Silver BK, Sibai AM, Norov B, Mayige MT, Martins JS, Lunet N, Labadarios D, Jorgensen JMA, Houehanou C, Guwatudde D, Gurung MS, Damasceno A, Aryal KK, Andall-Brereton G, Agoudavi K, McKenzie B, Webster J, Atun R, Bärnighausen T, Vollmer S, Davies JI, Geldsetzer P. Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data. PLoS Med 2021; 18:e1003485. [PMID: 33661979 PMCID: PMC7932723 DOI: 10.1371/journal.pmed.1003485] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. METHODS AND FINDINGS We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. CONCLUSIONS This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.
Collapse
Affiliation(s)
- David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Arpita Ghosh
- The George Institute for Global Health, UNSW Sydney, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
| | - Jennifer Manne-Goehler
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | | | | | - Adil Supiyev
- Laboratory of Epidemiology and Public Health, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana, Kazakhstan
| | | | - Abla M. Sibai
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bolormaa Norov
- National Center for Public Health, Ulaanbaatar, Mongolia
| | - Mary T. Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Joao S. Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mongal S. Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | | | - Krishna K. Aryal
- Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal
| | - Glennis Andall-Brereton
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Briar McKenzie
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqui Webster
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| |
Collapse
|
15
|
The cost of providing a community-based model of care to people with spinal cord injury, and the healthcare costs and economic burden to households of spinal cord injury in Bangladesh. Spinal Cord 2021; 59:833-841. [PMID: 33495581 DOI: 10.1038/s41393-020-00600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/08/2022]
Abstract
DESIGN Descriptive. SETTING Community, Bangladesh. OBJECTIVES To determine the costs associated with providing a community-based model of care delivered as part of the CIVIC trial to people discharged from hospital with recent spinal cord injury (SCI), and to determine the economic burden to households. METHODS Records were kept of the costs of providing a community-based model of care to participants of the CIVIC trial. Data were also collected at discharge and 2 years post discharge to capture out-of-pocket healthcare costs over the preceding 2 years, and the number of participants suffering catastrophic health expenditure and illness-induced poverty. RESULTS The mean cost of providing the community-based model of care to participants assigned to the intervention group (n = 204) was US$237 per participant. The mean out-of-pocket healthcare cost over the first 2 years post discharge was US$472 per participant (n = 410), and US$448 per control participant (n = 206). Median (IQR) equivalent annual household incomes prior to SCI and at 2 years post discharge were US$721 (US$452-1129) and US$464 (US$214-799), respectively. Of the 378 participants alive at 2 years, 324 (86%) had catastrophic health expenditure, and 161 of 212 participants who were not in poverty prior to injury (76%) were pushed into illness-induced poverty within 2 years of injury. CONCLUSION The cost of providing community-based support to people with SCI for 2 years post discharge in Bangladesh is relatively inexpensive but an overwhelming majority of households rapidly experience financial catastrophe, and most fall into poverty.
Collapse
|
16
|
Zheng B, Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Pocock SJ, Nhan VT, Alonso Garcia A, Chin CT, Jiang J, Jan S, Vega AM, Hayashi N, Ong TK. Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study. Clin Cardiol 2020; 43:999-1008. [PMID: 32618009 PMCID: PMC7462192 DOI: 10.1002/clc.23400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real‐world AMPs up to 2 years post discharge for ACS. Hypothesis There is wide variability in AMP use for ACS management in Asia. Methods EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months. Results Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow‐up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non‐randomized study. Conclusions Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.
Collapse
Affiliation(s)
- Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong, SAR, China
| | | | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| |
Collapse
|
17
|
Zarei L, Karimzadeh I, Moradi N, Peymani P, Asadi S, Babar ZUD. Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051710. [PMID: 32151039 PMCID: PMC7084506 DOI: 10.3390/ijerph17051710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.
Collapse
Affiliation(s)
- Leila Zarei
- Pharmacoeconomics and Pharma Management, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Iman Karimzadeh
- Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Najmeh Moradi
- Pharmacoeconomics and Pharma Management, Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, Iran
- Correspondence: ; Tel.: +98-9127932540
| | - Payam Peymani
- Pharmacoepidemiology, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
- Department of Clinical Pharmacology & Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sara Asadi
- Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Zaheer-Ud-Din Babar
- Medicines and Healthcare, Department of Pharmacy, University of Huddersfield, Queensgate, HD1 3DH Huddersfield, UK;
| |
Collapse
|
18
|
Krzhizhanovskaya VV, Závodszky G, Lees MH, Dongarra JJ, Sloot PMA, Brissos S, Teixeira J. Analyzing the Spatial Distribution of Acute Coronary Syndrome Cases Using Synthesized Data on Arterial Hypertension Prevalence. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303705 DOI: 10.1007/978-3-030-50423-6_36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In the current study, the authors demonstrate the method aimed at analyzing the distribution of acute coronary syndrome (ACS) cases in Saint Petersburg. The employed approach utilizes a synthetic population of Saint Petersburg and a statistical model for arterial hypertension prevalence. The number of ACS–related emergency services calls in an area is matched with the population density and the prospected number of individuals with arterial hypertension, which makes it possible to find locations with excessive ACS incidence. Three categories of locations, depending on the joint distribution of the above-mentioned indicators, are proposed as a result of data analysis. The method is implemented in Python programming language, the visualization is made using QGIS open software. The proposed method can be used to assess the prevalence of certain health conditions in the population and to match them with the corresponding severe health outcomes.
Collapse
|
19
|
Palagyi A, de Silva HA, Praveen D, Patel A. Combatting the Global Crisis of Cardiovascular Disease. Heart Lung Circ 2019; 28:981-983. [PMID: 31176388 DOI: 10.1016/j.hlc.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Devarsetty Praveen
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
20
|
Prinja S, Jagnoor J, Sharma D, Aggarwal S, Katoch S, Lakshmi PVM, Ivers R. Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One 2019; 14:e0224721. [PMID: 31697781 PMCID: PMC6837486 DOI: 10.1371/journal.pone.0224721] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure. Methods and analysis A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated. Results Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001). Conclusion The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.
Collapse
Affiliation(s)
- Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Deepshikha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Katoch
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rebecca Ivers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| |
Collapse
|
21
|
Sukkar L, Talbot B, Jun M, Dempsey E, Walker R, Hooi L, Cass A, Jardine M, Gallagher M. Protocol for the Study of Heart and Renal Protection-Extended Review: Additional 5-Year Follow-up of the Australian, New Zealand, and Malaysian SHARP Cohort. Can J Kidney Health Dis 2019; 6:2054358119879896. [PMID: 31662874 PMCID: PMC6794650 DOI: 10.1177/2054358119879896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background: There are limited studies on the effects of statins on outcomes in the
moderate chronic kidney disease (CKD) population and their trajectory to
end-stage kidney disease. Objective: To examine the long-term effects of lipid-lowering therapy on all-cause
mortality, cardiovascular morbidity, CKD progression, and socioeconomic
well-being in Australian, New Zealand, and Malaysian SHARP (Study of Heart
and Renal Protection) trial participants—a randomized controlled trial of a
combination of simvastatin and ezetimibe, compared with placebo, for the
reduction of cardiovascular events in moderate to severe CKD. Design: Protocol for an extended prospective observational follow-up. Setting: Australian, New Zealand, and Malaysian participating centers in patients with
advanced CKD. Patients: All SHARP trial participants alive at the final study visit. Measurements: Primary outcomes were measured by participant self-report and verified by
hospital administrative data. In addition, secondary outcomes were measured
using a validated study questionnaire of health-related quality of life, a
56-item economic survey. Methods: Participants were followed up with alternating face-to-face visits and
telephone calls on a 6-monthly basis until 5 years following their final
SHARP Study visit. In addition, there were 6-monthly follow-up telephone
calls in between these visits. Data linkage to health registries in
Australia, New Zealand, and Malaysia was also performed. Results: The SHARP-Extended Review (SHARP-ER) cohort comprised 1136 SHARP participants
with a median of 4.6 years of follow-up. Compared with all SHARP
participants who originally participated in the Australian, New Zealand, and
Malaysian regions, the SHARP-ER participants were younger (57.2 [48.3-66.4]
vs 60.5 [50.3-70.7] years) with a lower proportion of men (61.5% vs 62.8%).
There were a lower proportion of participants with hypertension (83.7% vs
85.0%) and diabetes (20.0% vs 23.5%). Limitations: As a long-term follow-up study, the surviving cohort of SHARP-ER is a
selected group of the original study participants, which may limit the
generalizability of the findings. Conclusion: The SHARP-ER study will contribute important evidence on the long-term
outcomes of cholesterol-lowering therapy in patients with advanced CKD with
a total of 10 years of follow-up. Novel analyses of the socioeconomic impact
of CKD over time will guide resource allocation. Trial Registration: The SHARP trial was registered at ClinicalTrials.gov NCT00125593 and ISRCTN
54137607.
Collapse
Affiliation(s)
- Louisa Sukkar
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ben Talbot
- The George Institute for Global Health, Newtown, Australia
| | - Min Jun
- The George Institute for Global Health, Newtown, Australia
| | - Erika Dempsey
- The George Institute for Global Health, Newtown, Australia
| | - Robert Walker
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lai Hooi
- Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Alan Cass
- Menzies School of Health Research, Casuarina, NT, Australia
| | - Meg Jardine
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Martin Gallagher
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| |
Collapse
|
22
|
Guan X, Fu M, Lin F, Zhu D, Vuillermin D, Shi L. Burden of visual impairment associated with eye diseases: exploratory survey of 298 Chinese patients. BMJ Open 2019; 9:e030561. [PMID: 31515429 PMCID: PMC6747637 DOI: 10.1136/bmjopen-2019-030561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the economic burden, prevalence of catastrophic healthcare expenditure (CHE) and the quality of life (QoL) of Chinese patients with visual impairment (VI) associated with eye diseases. DESIGN A questionnaire survey from March to May 2016 by structured face-to-face interviews of patients with VI. PARTICIPANTS 302 patients who were diagnosed with moderate VI or worse in both eyes (visual acuity <6/18) were included, and 298 patients (98.7%) who completed the survey questionnaires were eligible for the study. OUTCOME MEASURES The economic burden was estimated by calculating participants' direct costs covered in 2015 and the definition of CHE was out-of-pocket (OOP) costs exceeding 30% of annual household income. QoL was weighed by health utility value using time-trade-off valuation techniques. RESULTS Annual average direct costs per patient caused by VI were US$6988.6±US$10 834.3, and 70.3% were direct medical costs of which only 26.9% were reimbursable by medical insurance. 32.2% of households that suffered from CHE, in particular, were less wealthy patients with VI living in rural areas and without medical insurance. The health utility value was rated at 0.65 on average, and patients with VI aged 51-57, living alone and insured by commercial medical insurance had relatively less QoL. CONCLUSION Our study explored the economic burden and QoL of VI associated with patients with eye diseases in China, indicating a substantial economic burden and poor QoL. Preferential medical insurance policies should be designed in relation to people with VI to further reduce the health inequalities, avoid CHE and promote QoL.
Collapse
Affiliation(s)
- Xiaodong Guan
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Mengyuan Fu
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Fanghui Lin
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dawei Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | | | - Luwen Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| |
Collapse
|
23
|
Del Pozo-Rubio R, Mínguez-Salido R, Pardo-García I, Escribano-Sotos F. Catastrophic long-term care expenditure: associated socio-demographic and economic factors. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:691-701. [PMID: 30656482 DOI: 10.1007/s10198-019-01031-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An increasing number of persons across the world require long-term care (LTC). In Spain, access to LTC involves individuals incurring out-of-pocket (OOP) expenditure. There is a large body of literature on the incidence of catastrophic OOP payments in access and participation in health systems, but not in the field of LTC nor the determinants of these expenses. Our aim was to analyse the socio-demographic and economic factors associated with different levels of catastrophic LTC expenditure in the form of private out-of-pocket payments among dependent persons in Spain. MATERIALS AND METHODS The study used the Spanish Disability and Dependency Survey (SDDS) conducted by the Spanish National Statistics Institute to obtain the socioeconomic, demographic and health profiles. The households were classified into those below the poverty threshold and those above the threshold of catastrophe, using measures of impoverishment and catastrophe. We estimated two logistic regression models, one binary (impoverishment) and one ordinal (catastrophe). RESULTS The results show that OOP expenditure on LTC increases the probability of impoverishment by 18.90%. The factors associated with higher probability of experiencing catastrophe were age, being single, widowed or separated, lower levels of household income and education, higher level of dependence and living in an autonomous community with lower per capita income. CONCLUSIONS These findings highlight the need to include exemptions or insurance in the design of LTC policies to protect dependent persons from the risk of financial burden.
Collapse
Affiliation(s)
- Raúl Del Pozo-Rubio
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Román Mínguez-Salido
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
| | - Isabel Pardo-García
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain.
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Francisco Escribano-Sotos
- Department of Economics and Finance, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
| |
Collapse
|
24
|
Bhoo-Pathy N, Ng CW, Lim GCC, Tamin NSI, Sullivan R, Bhoo-Pathy NT, Abdullah MM, Kimman M, Subramaniam S, Saad M, Taib NA, Chang KM, Goh PP, Yip CH. Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action. J Oncol Pract 2019; 15:e537-e546. [PMID: 31112479 DOI: 10.1200/jop.18.00619] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses. RESULTS One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC. CONCLUSION Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.
Collapse
Affiliation(s)
| | - Chiu-Wan Ng
- 1 University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Richard Sullivan
- 4 Institute of Cancer Policy, King's Health Partners Guy's Hospital Campus, London, United Kingdom
| | | | | | - Merel Kimman
- 6 University Medical Centre, Maastricht, the Netherlands
| | | | | | | | | | - Pik-Pin Goh
- 7 Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | |
Collapse
|
25
|
Mohanan PP, Huffman MD, Baldridge AS, Devarajan R, Kondal D, Zhao L, Ali M, Joseph J, Eapen K, Krishnan MN, Menon J, Thomas M, Lloyd-Jones DM, Harikrishnan S, Prabhakaran D. Microeconomic Costs, Insurance, and Catastrophic Health Spending Among Patients With Acute Myocardial Infarction in India: Substudy of a Randomized Clinical Trial. JAMA Netw Open 2019; 2:e193831. [PMID: 31099866 PMCID: PMC6537817 DOI: 10.1001/jamanetworkopen.2019.3831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Ischemic heart disease is the leading cause of death in India, and treatment can be costly. OBJECTIVE To evaluate individual- and household-level costs and impoverishing effects of acute myocardial infarction among patients in Kerala, India. DESIGN, SETTING, AND PARTICIPANTS This investigation was a prespecified substudy of the Acute Coronary Syndrome Quality Improvement in Kerala study, a stepped-wedge, cluster randomized clinical trial conducted between November 2014 and November 2016 across 63 hospitals in Kerala, India. In this cross-sectional substudy, individual- and household-level cost data were collected 30 days after hospital discharge from a sample of 2114 respondents from November 2014 to July 2016. Data were analyzed from July through October 2018 and in March 2019. EXPOSURES Health insurance status. MAIN OUTCOMES AND MEASURES The primary outcomes were detailed direct and indirect cost data associated with acute myocardial infarction and respondent ability to pay as well as catastrophic health spending and distress financing. Catastrophic health spending was defined as 40% or more of household expenditures minus food costs spent on health, and distress financing was defined as borrowing money or selling assets to cover health costs. Hierarchical regression models were used to evaluate the association between health insurance and measures of financial risk. Costs were converted from Indian rupees to international dollars (represented herein as "$"). RESULTS Among 2114 respondents, the mean (SD) age was 62.3 (12.7) years, 1521 (71.9%) were men, 1144 (54.1%) presented with an ST-segment elevation myocardial infarction, and 1600 (75.7%) had no health insurance. The median (interquartile range) expenditure among respondents was $480.4 ($112.5-$1733.0) per acute myocardial infarction encounter, largely driven by in-hospital expenditures. There was greater than 15-fold variability between the 25th and 75th percentiles. Individuals with or without health insurance had similar monthly incomes and annual household expenditures, yet individuals without health insurance had approximately $400 higher out-of-pocket cardiovascular health care costs (median [interquartile range] total cardiovascular expenditures among uninsured, $560.3 [$134.1-$1733.6] vs insured, $161.4 [$23.2-$1726.9]; P < .001). Individuals without health insurance also had a 24% higher risk of catastrophic health spending (adjusted risk ratio, 1.24; 95% CI, 1.07-1.43) and 3-fold higher risk of distress financing (adjusted risk ratio; 3.05; 95% CI, 1.45-6.44). CONCLUSIONS AND RELEVANCE The results of this study indicate that acute myocardial infarction carries substantial financial risk for patients in Kerala. Expansion of health insurance may be an important strategy for financial risk protection to disrupt the poverty cycle associated with cardiovascular diseases in India.
Collapse
Affiliation(s)
| | - Mark D. Huffman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Raji Devarajan
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Dimple Kondal
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mumtaj Ali
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Johny Joseph
- Department of Cardiology, Caritas Hospital, Kottyam, India
| | - Koshy Eapen
- Department of Cardiology, Samaritan Hospital, Pazhangad, India
| | | | - Jaideep Menon
- Department of Cardiology, Sree Narayana Institute of Medical Sciences, Ernakulam, India
| | - Manoj Thomas
- Department of Cardiology, St Joseph’s Hospital, Dharmagiri, India
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
26
|
Nassr OA, Forsyth P, Johnson CF. Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq. Pharm Pract (Granada) 2019; 17:1372. [PMID: 31015874 PMCID: PMC6463406 DOI: 10.18549/pharmpract.2019.1.1372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/27/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.
Collapse
Affiliation(s)
- Ola A Nassr
- Department of clinical pharmacy, College of Pharmacy, Mustansiriya University. Baghdad, (Iraq).
| | - Paul Forsyth
- Lead Pharmacist for Clinical Cardiology (Primary Care). NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow, Scotland (United Kingdom).
| | - Chris F Johnson
- Specialist Mental Health and Prescribing Support Pharmacist Primary Care, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow, Scotland (United Kingdom).
| |
Collapse
|
27
|
Ortega-Ortega M, Del Pozo-Rubio R. Catastrophic financial effect of replacing informal care with formal care: a study based on haematological neoplasms. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:303-316. [PMID: 30121870 DOI: 10.1007/s10198-018-0998-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappearance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value = 9 €/h). Informal caregivers are a structural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.
Collapse
Affiliation(s)
- Marta Ortega-Ortega
- Department of Applied Economics, Public Economics and Political Economy. School of Economics and Business, Complutense University of Madrid, Campus de Somosaguas s/n. 28.023, Pozuelo de Alarcón, Madrid, Spain
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, Faculty of Social Sciences, University of Castilla-La Mancha, Avenida de los Alfares, 44, 16.071, Cuenca, Spain.
| |
Collapse
|
28
|
Tran BX, Tran TD, Nathan N, Ngo CQ, Nguyen LT, Nguyen LH, Nguyen HLT, Nguyen CT, Do HP, Nguyen THT, Tran TT, Thai TPT, Dang AK, Nguyen NB, Latkin CA, Ho CSH, Ho RCM. Catastrophic health expenditure of Vietnamese patients with gallstone diseases - a case for health insurance policy revaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:151-158. [PMID: 30804677 PMCID: PMC6375106 DOI: 10.2147/ceor.s191379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients. Materials and methods A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE. Results The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE. Conclusion The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending.
Collapse
Affiliation(s)
- Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Nila Nathan
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Chau Quy Ngo
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Loi Thi Nguyen
- Woolcock Institute of Medical Research Vietnam, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Huyen Phuc Do
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning, Friendship Hospital, Hanoi, Vietnam.,Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Nam Ba Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
29
|
Rijal A, Adhikari TB, Khan JAM, Berg-Beckhoff G. The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review. PLoS One 2018; 13:e0205745. [PMID: 30462648 PMCID: PMC6248902 DOI: 10.1371/journal.pone.0205745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. Method We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs—cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. Results A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. Conclusion The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.
Collapse
Affiliation(s)
- Anupa Rijal
- Young Earth, Kathmandu, Nepal
- Nepal Development Society, Chitwan, Nepal
- * E-mail:
| | - Tara Ballav Adhikari
- Nepal Development Society, Chitwan, Nepal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jahangir A. M. Khan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | |
Collapse
|
30
|
Al-Zakwani I, Zubaid M, Alsheikh-Ali AA, Almahmeed W, Rashed W. Effect of evidence-based cardiac drug therapy on mortality in patients with acute coronary syndrome: Findings from the Gulf COAST registry. Cardiovasc Ther 2018; 36:e12463. [PMID: 30079461 DOI: 10.1111/1755-5922.12463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/20/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022] Open
Abstract
AIM To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). METHODS Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. RESULTS The overall mean age of the cohort was 60 ± 13 years, 66% (n = 2436) were males. In all, 69% (n = 2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P = 0.824), EBM and GRACE risk score (P = 0.873) and between EBM and discharge diagnosis (P = 0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95% confidence interval (CI): 0.24-0.79; P = 0.007), which persisted at 6-months (aOR, 0.52; 95% CI: 0.38-0.72; P < 0.001) and at 12-months of follow-up (aOR, 0.58; 95% CI: 0.44-0.75; P < 0.001) posthospital discharge. CONCLUSIONS Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.
Collapse
Affiliation(s)
- Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.,Gulf Health Research, Muscat, Oman
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.,Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Wafa Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|
31
|
Prinja S, Bahuguna P, Duseja A, Kaur M, Chawla YK. Cost of Intensive Care Treatment for Liver Disorders at Tertiary Care Level in India. PHARMACOECONOMICS - OPEN 2018; 2:179-190. [PMID: 29623618 PMCID: PMC5972113 DOI: 10.1007/s41669-017-0041-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Liver diseases contribute significantly to the health and economic burden globally. We undertook this study to assess the health system costs, out-of-pocket (OOP) expenditure and extent of financial risk protection associated with treatment of liver disorders in a tertiary care public sector hospital in India. METHODOLOGY The present study was undertaken in an intensive care unit (ICU) of a tertiary care hospital in North India. It comprised an ICU and an HDU (high dependency unit). Bottom-up micro-costing was undertaken to assess the health system costs. Data on OOP expenditure and indirect costs were collected for 150 liver disorder patients admitted to the ICU or HDU from December 2013 to October 2014. Per-patient and per-bed-day costs of treatment were estimated from both health system and patient perspectives. Financial risk protection was assessed by computing prevalence of catastrophic health expenditure as a result of OOP expenditure. RESULTS In 2013-2014, health system costs per patient treated in the ICU and HDU were US$2728 [Indian National Rupee (INR) 1,63,664] and US$1966 (INR 1,17,985), respectively. The mean OOP expenditures for treatment in the ICU and HDU were US$2372 (INR 1,42,297) and US$1752 (INR 1,05,093), respectively. Indirect costs of hospitalization in ICU and HDU patients were US$166 (INR 9952) and US$182 (INR 10,903), respectively. CONCLUSION Treatment of chronic liver disorders poses an economic challenge for both the health system and patients. There is a need to focus on prevention of liver disorders, and finding ways to treat patients without exposing their households to the catastrophic effect of OOP expenditure.
Collapse
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Yogesh Kumar Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
32
|
Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, Mahal A, Griffiths U, McIntyre D, Meng Q, Nugent R, Atun R. Action to address the household economic burden of non-communicable diseases. Lancet 2018; 391:2047-2058. [PMID: 29627161 DOI: 10.1016/s0140-6736(18)30323-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
Collapse
Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Beverley M Essue
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janani Muhunthan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Engelgau
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, China
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| |
Collapse
|
33
|
Wu D, Yu F, Nie W. Improvement of the reduction in catastrophic health expenditure in China's public health insurance. PLoS One 2018; 13:e0194915. [PMID: 29634779 PMCID: PMC5892907 DOI: 10.1371/journal.pone.0194915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.
Collapse
Affiliation(s)
- Dengfeng Wu
- Economics and Management School, Jiujiang University, Jiujiang City, China
- * E-mail:
| | - Fang Yu
- Economics and Management School, Jiujiang University, Jiujiang City, China
| | - Wei Nie
- Jiujiang University Hospital, Jiujiang City, China
| |
Collapse
|
34
|
ARYANKHESAL A, ETEMADI M, MOHSENI M, AZAMI-AGHDASH S, NAKHAEI M. Catastrophic Health Expenditure in Iran: A Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:166-177. [PMID: 29445626 PMCID: PMC5810379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND One of the main challenges of healthcare systems is to protect people from consequences of health expenditures. Such expenditures may lead to catastrophic financial loss in families so that many people deny demanding necessary healthcare services, which results in harms to their health status. The aim of this systematic review was to investigate the catastrophic health expenditures trend and its related factors in Iran. METHODS This systematic review and meta-analysis was conducted on studies conducted between 1984 and 2014. Data were collected through searching electronic databases and searching engines of PubMed, Scopus, EconLit, Google Scholar, Science Direct, MagIran, and Scientific Information Database (SID). The random effects were used with 95% confidence interval for the meta-analysis. RESULTS Out of 561 initially retrieved articles, finally 42 were included in the final analysis. The studies were conducted between 1984 and 2014. The overall proportion of exposure to catastrophic health expenditure in Iran was 7.5% (95% CI, 6.2 - 9.1). In the urban and rural areas, the proportion was 2.3% (95% CI, 1.8 - 2.9) and 3.4% (95% CI, 2.8 - 4.1) respectively. The overall proportion of exposure to the catastrophic health expenditure in hospitals was 35.9% (95% CI, 23.5 - 54.3). CONCLUSION The catastrophic expenditures proportion of healthcare is relatively high in Iran and the government is expected to adopt effective measures in this regard, especially for the inpatient care. There are needs for special supporting policies for the financial protection of specific patients, the poor and villagers.
Collapse
Affiliation(s)
- Aidin ARYANKHESAL
- Dept. of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Manal ETEMADI
- Dept. of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Mohammad MOHSENI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saber AZAMI-AGHDASH
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid NAKHAEI
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
35
|
Kien VD, Minh HV, Ngoc NB, Phuong TB, Ngan TT, Quam MB. Inequalities in Household Catastrophic Health Expenditure and Impoverishment Associated With Noncommunicable Diseases in Chi Linh, Hai Duong, Vietnam. Asia Pac J Public Health 2017; 29:35S-44S. [PMID: 28719772 DOI: 10.1177/1010539517712919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A costly modern-day double burden, the expenses of noncommunicable diseases (NCDs) are becoming a devastating epidemic. The World Health Organization estimates $7 trillion in economic losses from NCDs in 2011-2025. Although regarded as affluent diseases, the burden of NCDs is shifting into poorer groups. In this study, we assessed the socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with NCDs in Northern Vietnam. We also identified associated factors for catastrophic health expenditure and impoverishment. Households self-reporting NCD diagnoses had the highest association with both catastrophic health expenditure and impoverishment, followed by those in urban areas. Such households were likely poorer according to our calculations estimating socioeconomic inequalities. Households with at least 1 member older than 60 years were also more likely to suffer catastrophic health expenditures. These findings suggest that targeted policy to prevent or subsidize care for NCDs could prevent catastrophic health expenditure and impoverishment among those already most disadvantaged.
Collapse
Affiliation(s)
- Vu Duy Kien
- 1 Hanoi University of Public Health, Hanoi, Vietnam
| | | | | | | | | | | |
Collapse
|
36
|
Tolla MT, Norheim OF, Verguet S, Bekele A, Amenu K, Abdisa SG, Johansson KA. Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study. BMJ Glob Health 2017; 2:e000280. [PMID: 29242752 PMCID: PMC5584490 DOI: 10.1136/bmjgh-2016-000280] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/07/2017] [Accepted: 04/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiovascular disease poses a great financial risk on households in countries without universal health coverage like Ethiopia. This paper aims to estimate the magnitude and intensity of catastrophic health expenditure and factors associated with catastrophic health expenditure for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa. METHODS AND FINDINGS We conducted a cross-sectional cohort study among individuals who sought cardiovascular disease care in selected hospitals in Addis Ababa during February to March 2015 (n=589, response rate 94%). Out-of-pocket payments on direct medical costs and direct non-medical costs were accounted for. Descriptive statistics was used to estimate the magnitude and intensity of catastrophic health expenditure within households, while logistic regression models were used to assess the factors associated with it.About 27% (26 .7;95% CI 23.1 to 30.6) of the households experienced catastrophic health expenditure, defined as annual out-of-pocket payments above 10% of a household's annual income. Family support was the the most common coping mechanism. Low income, residence outside Addis Ababa and hospitalisation increased the likelihood of experiencing catastrophic health expenditure. The bottom income quintile was about 60 times more likely to suffer catastrophic health expenditure compared with the top quintile (adjusted OR=58.6 (16.5-208.0), p value=0.00). Of those that experienced catastrophic health expenditure, the poorest and richest quintiles spent on average 34% and 15% of households' annual income, respectively. Drug costs constitute about 50% of the outpatient care cost. CONCLUSIONS Seeking prevention and treatment services for cardiovascular disease in Addis Ababa poses substantial financial burden on households, affecting the poorest and those who reside outside Addis Ababa more. Economic and geographical inequalities should also be considered when setting priorities for expanding coverage of these services. Expanded coverage has to go hand-in-hand with implementation of sound prepayment and risk pooling arrangements to ensure financial risk protection to the most needy.
Collapse
Affiliation(s)
- Mieraf Taddesse Tolla
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Abebe Bekele
- Department of Health Systems Research, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kassahun Amenu
- Department of Health Systems Research, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Senbeta Guteta Abdisa
- Department of Internal Medicine, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| |
Collapse
|
37
|
Shan L, Wu Q, Liu C, Li Y, Cui Y, Liang Z, Hao Y, Liang L, Ning N, Ding D, Pan Q, Han L. Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China. BMJ Open 2017; 7:e014425. [PMID: 28576890 PMCID: PMC5623424 DOI: 10.1136/bmjopen-2016-014425] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. METHODS A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. RESULTS There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. CONCLUSION Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members, including low levels of entitlements, large healthcare inequity, limited financial protection and poor portability. A singular amendment of the structural design of the existing funds may not be enough to offer a satisfactory solution to these identified barriers. There is a need to increase funding capacities, to develop unified and consistent policies and to increase the level of fund pooling.
Collapse
Affiliation(s)
- Linghan Shan
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ye Li
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Cui
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zi Liang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Libo Liang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Ning Ning
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Ding Ding
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qingxia Pan
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Liyuan Han
- Department of Preventive Medicine, School of Medical, Ningbo University, Ningbo, Zhejiang province, China
| |
Collapse
|
38
|
Policy and priorities for national cancer control planning in low- and middle-income countries: Lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study. Eur J Cancer 2017; 74:26-37. [DOI: 10.1016/j.ejca.2016.12.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022]
|