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Manjate NJ, Martins JD, Amado R, Nhanombe A, Canana N, Cumbi L, Pires G, Muamine E, Cambe MI, Domingos A, Chicumbe S. Estimating the cost for obstetric fistula repair in hospitals of Mozambique: a low-income country. HEALTH ECONOMICS REVIEW 2024; 14:65. [PMID: 39186146 PMCID: PMC11346298 DOI: 10.1186/s13561-024-00542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/24/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012-2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique. METHODS We carried out a retrospective evaluation, from the provider's perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets' costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included. RESULTS The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294). CONCLUSION Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).
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Affiliation(s)
- Nelmo Jordão Manjate
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique.
| | - Janet Dulá Martins
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Regina Amado
- Instituto de Higiene e Medicina Tropical da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Armindo Nhanombe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Neide Canana
- Malaria Consortium, Cidade de Maputo, Moçambique
| | - Laurentino Cumbi
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Germano Pires
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Elídio Muamine
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Maria Isabel Cambe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
| | - Ausenda Domingos
- Fundo das Nações Unidas para População (UNFPA), Cidade de Maputo, Moçambique
| | - Sérgio Chicumbe
- Programa de Sistemas de Saúde, Distrito de Marracuene, Instituto Nacional de Saúde de Moçambique, Estrada Nacional nº 1, Bairro da Vila - Parcela 3934, Província de Maputo, Moçambique
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Jain N, Wijnen B, Lohumi I, Chatterjee S, Evers SMAA. Economic burden of suicides and suicide attempts in low- and middle-income countries: a systematic review of costing studies. Expert Rev Pharmacoecon Outcomes Res 2024:1-13. [PMID: 39099300 DOI: 10.1080/14737167.2024.2388132] [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: 09/28/2023] [Revised: 06/25/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Suicide is a major public health concern in low- and middle-income countries (LMICs) due to its substantial psychological, social, and economic impact. There is little synthesized evidence to estimate the economic burden of suicide and suicide attempts in such economies. The present systematic literature review aims to examine existing evidence on the cost of illness (COI) in the case of suicides and suicide attempts and assess their quality. METHODS A systematic review was carried out using electronic databases, such as Medline, EMBASE, EconLit, PsycINFO, and CINAHL using keywords like 'suicide and suicide attempts,' 'cost of illness,' and economic burden." The quality assessment of studies was conducted along with the per-person cost estimation to understand the variation of methods followed across the studies. RESULT 14 studies qualified for final data extraction and synthesis out of 4,164 studies. The studies showed heterogeneity across objectives, settings, and methods, with cost estimates reflecting a wide range of costings per person in suicide and suicide attempts. CONCLUSION It is challenging to determine and compare the economic estimates of suicide. Intensive research is warranted with standardized cost assessment techniques and wider perspectives to understand the true economic burden of suicide. REGISTRATION PROSPERO Registration No- CRD42022294080.
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Affiliation(s)
- Nikhil Jain
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centre for Mental Health, Law and Policy, Indian Law Society, Pune, India
| | - Ben Wijnen
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Isha Lohumi
- Centre for Mental Health, Law and Policy, Indian Law Society, Pune, India
| | | | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
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Kazemi Z, Emamgholipour S, Daroudi R, Yunesian M, Hassanvand MS. Estimation and determinants of direct hospitalisation cost for coronary heart disease in a low-middle-income country: evidence from a nationwide study in Iranian hospitals. BMJ Open 2024; 14:e074711. [PMID: 39117417 PMCID: PMC11407203 DOI: 10.1136/bmjopen-2023-074711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the most prevalent type of cardiovascular disease in Iran. This study aims to investigate the estimation and determinants of direct hospitalisation cost for patients with CHD in Iranian hospitals. METHODS We identified patients with CHD in Iran in 2019-2020. Data were gathered from the Iran Health Insurance Organisation information systems and the Ministry of Health and Medical Education. This was a cross-sectional prevalence-based study. Generalised linear models were used to find the determinants of hospitalisation cost for patients with CHD. A total of 86 834 patients suffering from CHD were studied. RESULTS Mean hospitalisation cost per CHD patient was US$382.90±US$500.72 while the mean daily hospitalisation cost per CHD patient was US$89.71±US$89.99. In-hospital mortality of CHD was 2.52%. Hospitalisation accommodation and medications had the highest share of hospitalisation costs (25.59% and 22.63%, respectively). Men spent 1.12 (95% CI 1.11 to 1.13) times more on hospitalisation costs compared with women, and individuals aged 60 to 69 had hospitalisation costs 1.04 (95% CI 1.02 to 1.06) times higher than those in the 0-49 age range. Patients insured by the Iranian Fund have significantly higher costs 1.17 (95% CI 1.14 to 1.19) than the Rural fund. Hospitalisation costs for patients with CHD who received surgery and angiography were significantly 2.36 (95% CI 2.30 to 2.43) times higher than for patients who did not undergo surgery and angiography. CONCLUSION Applying CHD prevention strategies for men and the middle-aged population (50-70 years) is strongly recommended. Prudent use and prescribing of medications will be helpful to reduce hospitalisation cost.
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Affiliation(s)
- Zohreh Kazemi
- Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran (the Islamic Republic of)
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Sara Emamgholipour
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- National Center for Health Insurance Research, Tehran, Iran (the Islamic Republic of)
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Dzingirai B, Katsidzira L, Mwanesani V, Postma MJ, van Hulst M, Mafirakureva N. A cost analysis of a simplified model for HCV screening and treatment at a tertiary hospital in Zimbabwe. Expert Rev Pharmacoecon Outcomes Res 2024; 24:687-695. [PMID: 38716801 DOI: 10.1080/14737167.2024.2348055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The treatment of chronic hepatitis C virus (HCV) infection using directly acting antivirals was recently adopted in the treatment guidelines of Zimbabwe. The objectives of this study were to design a simplified model of HCV care and estimate the cost of screening and treatment of hepatitis C infection at a tertiary hospital in Zimbabwe. METHODS We developed a model of care for HCV using WHO 2018 guidelines for the treatment of HCV infection and expert opinion. We then performed a micro-costing to estimate the costs of implementing the model of care from the healthcare sector perspective. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty in input parameters on the estimated total cost of care. RESULTS The total cost of screening and treatment was estimated to be US$2448 (SD=$290) per patient over a 12-week treatment duration using sofosbuvir/velpatasvir. The cost of directly acting antivirals contributed 57.5% to the total cost of care. The second largest cost driver was the cost of diagnosis, US$819, contributing 34.6% to the total cost of care. CONCLUSION Screening and treatment of HCV-infected individuals using directly acting antivirals at a tertiary hospital in Zimbabwe may require substantial financial resources.
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Affiliation(s)
- Blessing Dzingirai
- Unit of Global Health, Department of Health Sciences, Üniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Leolin Katsidzira
- Department of Medicine, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
| | - Vongai Mwanesani
- Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Maarten Jacobus Postma
- Unit of Global Health, Department of Health Sciences, Üniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marinus van Hulst
- Unit of Global Health, Department of Health Sciences, Üniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
| | - Nyashadzaishe Mafirakureva
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Turnbull MR, Gallo TF, Carter HE, Drew M, Toohey LA, Waddington G. Estimating the cost of sports injuries: A scoping review. J Sci Med Sport 2024; 27:307-313. [PMID: 38514294 DOI: 10.1016/j.jsams.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Provide an overview of the methods used to estimate the cost of sports-related injury published to date, and to highlight considerations and opportunities for future research. DESIGN Scoping review. METHODS Scopus, MEDLINE and CINHAL were searched from 1st January 2000 to 1st January 2023. Studies were screened by two independent reviewers and were eligible if they reported on a cost analysis or cost estimation of sports related injury. RESULTS Thirty-one studies fulfilled the inclusion criteria. Twenty-seven studies (87 %) were published since 2014. The type of costs included direct healthcare costs (12 studies), indirect costs (10 studies) and a combination of both (9 studies). Twenty-one studies (68 %) used a bottom-up costing approach to measure costs of sports injury and estimated direct costs from the service rates or fee schedules of health systems, hospital, insurance companies or national insurance boards. A top-down approach was used in seven studies (23 %) to estimate the indirect salary cost of time-loss injuries using data from publicly available resources. Ten studies were from the cost perspective of a sporting organisation (32 %). There was a lack of explicit reporting of the costing method used and the perspective of those bearing the costs. CONCLUSIONS Estimating the cost of sports injuries is an emerging area of research, with publications increasing in recent years. However, there remains a lack of methodological guidance to inform or appraise these studies. The expansion of established cost of illness checklists with sport injury explanations to guide future cost of sports injury studies is recommended.
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Affiliation(s)
- Matthew R Turnbull
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
| | - Tania F Gallo
- Cricket Australia, Australia. https://twitter.com/TG2389
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia. https://twitter.com/Hannah_E_Carter
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia. https://twitter.com/_mickdrew
| | - Liam A Toohey
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia; Australian Institute of Sport, Australia. https://twitter.com/LiamAToohey
| | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia; Australian Institute of Sport, Australia. https://twitter.com/DrGWaddington
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Twea P, Watkins D, Norheim OF, Munthali B, Young S, Chiwaula L, Manthalu G, Nkhoma D, Hangoma P. The economic costs of orthopaedic services: a health system cost analysis of tertiary hospitals in a low-income country. HEALTH ECONOMICS REVIEW 2024; 14:13. [PMID: 38367132 PMCID: PMC10874068 DOI: 10.1186/s13561-024-00485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Traumatic injuries are rising globally, disproportionately affecting low- and middle-income countries, constituting 88% of the burden of surgically treatable conditions. While contributing to the highest burden, LMICs also have the least availability of resources to address this growing burden effectively. Studies on the cost-of-service provision in these settings have concentrated on the most common traumatic injuries, leaving an evidence gap on other traumatic injuries. This study aimed to address the gap in understanding the cost of orthopaedic services in low-income settings by conducting a comprehensive costing analysis in two tertiary-level hospitals in Malawi. METHODS We used a mixed costing methodology, utilising both Top-Down and Time-Driven Activity-Based Costing approaches. Data on resource utilisation, personnel costs, medicines, supplies, capital costs, laboratory costs, radiology service costs, and overhead costs were collected for one year, from July 2021 to June 2022. We conducted a retrospective review of all the available patient files for the period under review. Assumptions on the intensity of service use were based on utilisation patterns observed in patient records. All costs were expressed in 2021 United States Dollars. RESULTS We conducted a review of 2,372 patient files, 72% of which were male. The median length of stay for all patients was 9.5 days (8-11). The mean weighted cost of treatment across the entire pathway varied, ranging from $195 ($136-$235) for Supracondylar Fractures to $711 ($389-$931) for Proximal Ulna Fractures. The main cost components were personnel (30%) and medicines and supplies (23%). Within diagnosis-specific costs, the length of stay was the most significant cost driver, contributing to the substantial disparity in treatment costs between the two hospitals. CONCLUSION This study underscores the critical role of orthopaedic care in LMICs and the need for context-specific cost data. It highlights the variation in cost drivers and resource utilisation patterns between hospitals, emphasising the importance of tailored healthcare planning and resource allocation approaches. Understanding the costs of surgical interventions in LMICs can inform policy decisions and improve access to essential orthopaedic services, potentially reducing the disease burden associated with trauma-related injuries. We recommend that future studies focus on evaluating the cost-effectiveness of orthopaedic interventions, particularly those that have not been analysed within the existing literature.
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Affiliation(s)
- Pakwanja Twea
- University of Bergen, Bergen, Norway.
- Ministry of Health, Lilongwe, Malawi.
| | | | | | - Boston Munthali
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | - Sven Young
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | | | | | | | - Peter Hangoma
- University of Bergen, Bergen, Norway
- Chr. Michelson Institute (CMI), Bergen, Norway
- University of Zambia, Lusaka, Zambia
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Cheng Q, Dang T, Nguyen TA, Velen K, Nguyen VN, Nguyen BH, Vu DH, Long CH, Do TT, Vu TM, Marks GB, Yapa M, Fox GJ, Wiseman V. mHealth application for improving treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam: an economic evaluation protocol for the V-SMART trial. BMJ Open 2023; 13:e076778. [PMID: 38081668 PMCID: PMC10729151 DOI: 10.1136/bmjopen-2023-076778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION The Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART) trial is a randomised controlled trial of using mobile health (mHealth) technologies to improve adherence to medications and management of adverse events (AEs) in people with multidrug-resistant tuberculosis (MDR-TB) undergoing treatment in Vietnam. This economic evaluation seeks to quantify the cost-effectiveness of this mHealth intervention from a healthcare provider and societal perspective. METHODS AND ANALYSIS The V-SMART trial will recruit 902 patients treated for MDR-TB across seven participating provinces in Vietnam. Participants in both intervention and control groups will receive standard community-based therapy for MDR-TB. Participants in the intervention group will also have a purpose-designed App installed on their smartphones to report AEs to health workers and to facilitate timely management of AEs. This economic evaluation will compare the costs and health outcomes between the intervention group (mHealth) and the control group (standard of care). Costs associated with delivering the intervention and health service utilisation will be recorded, as well as patient out-of-pocket costs. The health-related quality of life (HRQoL) of study participants will be captured using the 36-Item Short Form Survey (SF-36) questionnaire and used to calculate quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) will be based on the primary outcome (proportion of patients with treatment success after 24 months) and QALYs gained. Sensitivity analysis will be conducted to test the robustness of the ICERs. A budget impact analysis will be conducted from a payer perspective to provide an estimate of the total budget required to scale-up delivery of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the University of Sydney Human Research Ethics Committee (2019/676), the Scientific Committee of the Ministry of Science and Technology, Vietnam (08/QD-HDQL-NAFOSTED) and the Institutional Review Board of the National Lung Hospital, Vietnam (13/19/CT-HDDD). Study findings will be published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tho Dang
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Binh Hoa Nguyen
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Dinh Hoa Vu
- Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Thu Thuong Do
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Truong-Minh Vu
- Ho Chi Minh City Institute for Development Studies, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Manisha Yapa
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Trotignon G, Dixon R, Atekem K, Senyonjo L, Kamgno J, Biholong D, Jones I, Nditanchou R. Cost of implementing a doxycycline test-and-treat strategy for onchocerciasis elimination among settled and semi-nomadic groups in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011670. [PMID: 37851655 PMCID: PMC10615284 DOI: 10.1371/journal.pntd.0011670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/30/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Onchocerciasis is a neglected tropical disease with 217.5 million people globally at risk of having the infection. In both settled and semi-nomadic communities of Massangam Health District in Cameroon, Sightsavers has been carrying out test-and-treat with doxycycline and twice-yearly ivermectin distribution. This paper focuses on the cost of test-and-treat with doxycycline in the two community contexts of settled and semi-nomadic. METHODS For the valuation, a combination of gross or micro-costing was used to identify cost components, as well as bottom-up and top-down approaches. The opportunity costs of vehicle and equipment use were estimated and included. Not included, however, were the opportunity costs of building use and Ministry of Public Health staff salaries. We only captured the incremental costs of implementing test-and-treat activities as part of a functional annual community-directed treatment with the ivermectin programme. RESULTS We estimate the economic cost per person tested and cost per person treated in Massangam to be US$135 and US$667 respectively. Total implementation cost in the settled community was US$79,409, and in the semi-nomadic community US$69,957. Overall, the total economic cost of implementing the doxycycline test-and-treat strategy for onchocerciasis elimination in Massangam came to US$168,345. Financial costs represented 91% of total costs. CONCLUSIONS Unit costs of test-and-treat in both settled and semi-nomadic communities are higher than unit costs of community-directed treatment with ivermectin. However, it is critical to note that a two-year implementation shows a significantly larger reduction in infection prevalence than the preceding 20 years of annual community-directed treatment with ivermectin. Test-and-treat with doxycycline may be a cost-effective intervention in places where the prevalence of microfilaria is still high, or in hard-to-reach areas where community-directed treatment with ivermectin and MDA coverage are not high enough to stop transmission or where marginalised populations consistently miss treatment.
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Affiliation(s)
| | - Ruth Dixon
- Sightsavers, Haywards Heath, United Kingdom
| | - Kareen Atekem
- Sightsavers, Cameroon Country Office, Yaoundé, Cameroon
| | | | - Joseph Kamgno
- Centre de recherche sur la filariose et d’autres maladies tropicales (CRFilMT), Fouda Quarter, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé; Yaounde, Cameroon
| | - Didier Biholong
- National Programme for the Control of Lymphatic Filariasis and onchocerciasis, Ministry of Public Health, Yaoundé, Cameroon
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
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Sin MP, Hasan MZ, Forsberg BC. Change in economic burden of diarrhoea in children under-five in Bangladesh: 2007 vs. 2018. J Glob Health 2023; 13:04089. [PMID: 37622687 PMCID: PMC10451101 DOI: 10.7189/jogh.13.04089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background In Bangladesh, diarrhoea in children under-five is a major public health problem with cost implications. Although under-five diarrhoea mortality and morbidity have declined from 2007 to 2018, change in the economic burden is unknown. This study determined the change in the societal economic burden of under-five diarrhoea in Bangladesh comparing 2007 to 2018. Methods A prevalence-based, retrospective cost analysis was conducted from a societal perspective, including costs to households, providers, and economic loss from premature deaths. Data were obtained from the previous cost of illness studies, government reports, and international databases. Direct costs for treatment were estimated by the bottom-up costing approach. Indirect costs on the loss of productivity of caretakers and loss from premature deaths were calculated by the human capital method. Total costs were presented in both local currency (Bangladeshi Taka (BDT)) and US dollars (US$)) in 2018 price. Sensitivity analyses were conducted to assess the robustness of the input parameters. Results A 36.4% reduction was found on the economic burden of under-five diarrhoea when comparing 2007 and 2018; US$1 209 million (95% CI = 1066 million-1299 million) for 2007 and US$769 million (95% CI = 484 million-873 million) for 2018. Economic loss from premature deaths imposed the highest costs (2007 = 66%, 2018 = 66% of all) followed by indirect costs on the loss of productivity of caretakers (2007 = 21%, 2018 = 26%) and direct medical costs (2007 = 13%, 2018 = 8%). Conclusions Societal costs from diarrhoeal diseases were reduced from 2007 to 2018 in Bangladesh. However, the economic burden was equivalent to 0.29% of country's gross domestic product in 2018 and remains a challenge. The major contributor to the costs was premature mortality from diarrhoeal diseases. Premature deaths are still prevalent though they to a large extent are avoidable. To further limit the economic burden, under-five diarrhoea mortality and morbidity reduction should be accelerated.
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Affiliation(s)
- May Phyu Sin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Md Zahid Hasan
- Health Systems and Population Studies Division, ICDDR,B, Mohakhali, Dhaka, Bangladesh
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Genemo I, Chala TK, Hordofa DF, Sinkie SO. Cost and Cost-Effectiveness of Treating Childhood Cancer at Jimma Medical Center. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:433-442. [PMID: 37309357 PMCID: PMC10257924 DOI: 10.2147/ceor.s395170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Background More than 70% of childhood cancer patients die in Sub-Saharan African countries due to a lack of access. Additionally establishing a childhood cancer treatment service is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of evidence on the actual cost and cost-effectiveness of this service in LMICs including Ethiopia. This study provides context-relevant evidence to consider childhood cancer treatment in the healthcare priority settings in Ethiopia and other LMICs. Methods Newly admitted case files of children for the year 2020/21 were reviewed. The cost was analyzed from the provider's perspective. The effectiveness was calculated using DALY averted based on the 5 years of survival rates, which is estimated from the 1-year survival rate of Kaplan-Meier output. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate, and life expectancy. Results During the study period, 101 children were treated in the unit. The total annual and unit cost to give treatment to childhood cancer patients was estimated at $279,648 and $2769, respectively. The highest per-patient annual unit cost of treatment was Hodgkin's lymphoma ($6252), while Retinoblastoma ($1520) was the least. The cost per DALY averted was $193, which is significantly less than Ethiopia's GDP per capita ($936.3). The results remained very cost-effective in sensitivity analyses. Conclusion Childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in a conservative adjustment of assumptions. Therefore, to enhance and improve children's health, childhood cancer should get a better concern in health priority.
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Affiliation(s)
- Idiris Genemo
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Temesgen Kabeta Chala
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Diriba Fufa Hordofa
- Department of Pediatric Oncology Unit, Jimma University, Jimma, Oromia, Ethiopia
| | - Shimeles Ololo Sinkie
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
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11
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Rosu L, Madan JJ, Tomeny EM, Muniyandi M, Nidoi J, Girma M, Vilc V, Bindroo P, Dhandhukiya R, Bayissa AK, Meressa D, Narendran G, Solanki R, Bhatnagar AK, Tudor E, Kirenga B, Meredith SK, Nunn AJ, Bronson G, Rusen ID, Squire SB, Worrall E. Economic evaluation of shortened, bedaquiline-containing treatment regimens for rifampicin-resistant tuberculosis (STREAM stage 2): a within-trial analysis of a randomised controlled trial. Lancet Glob Health 2023; 11:e265-e277. [PMID: 36565704 DOI: 10.1016/s2214-109x(22)00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The STREAM stage 2 trial assessed two bedaquiline-containing regimens for rifampicin-resistant tuberculosis: a 9-month all-oral regimen and a 6-month regimen containing an injectable drug for the first 2 months. We did a within-trial economic evaluation of these regimens. METHODS STREAM stage 2 was an international, phase 3, non-inferiority randomised trial in which participants with rifampicin-resistant tuberculosis were randomly assigned (1:2:2:2) to the 2011 WHO regimen (terminated early), a 9-month injectable-containing regimen (control regimen), a 9-month all-oral regimen with bedaquiline (oral regimen), or a 6-month regimen with bedaquiline and an injectable for the first 2 months (6-month regimen). We prospectively collected direct and indirect costs and health-related quality of life data from trial participants until week 76 of follow-up. Cost-effectiveness of the oral and 6-month regimens versus control was estimated in four countries (oral regimen) and two countries (6-month regimen), using health-related quality of life for cost-utility analysis and trial efficacy for cost-effectiveness analysis. This trial is registered with ISRCTN, ISRCTN18148631. FINDINGS 300 participants were included in the economic analyses (Ethiopia, 61; India, 142; Moldova, 51; Uganda, 46). In the cost-utility analysis, the oral regimen was not cost-effective in Ethiopia, India, Moldova, and Uganda from either a provider or societal perspective. In Moldova, the oral regimen was dominant from a societal perspective. In the cost-effectiveness analysis, the oral regimen was likely to be cost-effective from a provider perspective at willingness-to-pay thresholds per additional favourable outcome of more than US$4500 in Ethiopia, $1900 in India, $3950 in Moldova, and $7900 in Uganda, and from a societal perspective at thresholds of more than $15 900 in Ethiopia, $3150 in India, and $4350 in Uganda, while in Moldova the oral regimen was dominant. In Ethiopia and India, the 6-month regimen would cost tuberculosis programmes and participants less than the control regimen and was highly likely to be cost-effective in both cost-utility analysis and cost-effectiveness analysis. Reducing the bedaquiline price from $1·81 to $1·00 per tablet made the oral regimen cost-effective in the provider-perspective cost-utility analysis in India and Moldova and dominate over the control regimen in the provider-perspective cost-effectiveness analysis in India. INTERPRETATION At current costs, the oral bedaquiline-containing regimen for rifampicin-resistant tuberculosis is unlikely to be cost-effective in many low-income and middle-income countries. The 6-month regimen represents a cost-effective alternative if injectable use for 2 months is acceptable. FUNDING USAID and Janssen Research & Development.
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Affiliation(s)
- Laura Rosu
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ewan M Tomeny
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Jasper Nidoi
- Makerere University Lung Institute, Kampala, Uganda
| | - Mamo Girma
- Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Valentina Vilc
- Institute of Phthisiopneumology Chiril Draganiuc, Chisinau, Moldova
| | - Priyanka Bindroo
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, Delhi, India
| | | | | | - Daniel Meressa
- St Peter's Tuberculosis Specialized Hospital and Global Health Committee, Addis Ababa, Ethiopia
| | | | | | - Anuj K Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, Delhi, India
| | - Elena Tudor
- Institute of Phthisiopneumology Chiril Draganiuc, Chisinau, Moldova
| | | | - Sarah K Meredith
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | | | | | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Kenne Malaha A, Thébaut C, Achille D, Preux PM, Guerchet M. Costs of Dementia in Low- And Middle-Income Countries: A Systematic Review. J Alzheimers Dis 2023; 91:115-128. [PMID: 36404540 DOI: 10.3233/jad-220239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The proportion of people living with dementia in low- and middle-income countries (LMICs) is expected to reach 71% by 2050. Appraising the economic burden of the disease may contribute to strategic policy planning. OBJECTIVE To review studies conducted on the costs of dementia in LMICs, describe their methodology and summarize available costs estimates. METHODS Systematic review, including a search of health, economics, and social science bibliographic databases. No date or language restrictions were applied. All studies with a direct measure of the costs of dementia care were included. RESULTS Of the 6,843 publications reviewed, 17 studies from 11 LMICs were included. Costs of dementia tended to increase with the severity of the disease. Medical costs were greater in the mild stage, while social and informal care costs were highest in the moderate and severe stages. Annual cost estimates per patient ranged from PPP$131.0 to PPP$31,188.8 for medical costs; from PPP$16.1 to PPP$10,581.7 for social care services and from PPP$140.0 to PPP$25,798 for informal care. Overall, dementia care can cost from PPP$479.0 to PPP$66,143.6 per year for a single patient. CONCLUSION Few studies have been conducted on the costs of dementia in LMICs, and none so far in Africa. There seems to be a need to provide accurate data on the burden of disease in these countries to guide public health policies in the coming decades.
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Affiliation(s)
- Angeladine Kenne Malaha
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Clémence Thébaut
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France.,Leda-Legos, PSL Research University, Paris Dauphine University, Paris, France
| | - Dayna Achille
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France.,CHU, Centre d'Epidémiologie de Biostatistiqueet de Méthodologie de la Recherche, Limoges, France
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
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13
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Ismail NE, Jimam NS, Goh KW, Tan CS, Ming LC. Economic Burdens of Uncomplicated Malaria in Primary Health Care (PHC) Facilities of Plateau State, Nigeria: Patients' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1093. [PMID: 36673849 PMCID: PMC9859025 DOI: 10.3390/ijerph20021093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aims at evaluating the costs incurred by patients in Primary Healthcare facilities of Plateau State, Nigeria, due to uncomplicated malaria management. METHODS Patients' information on resources used and absence from the labour market due to uncomplicated malaria illness were collected using the self-reported cost of illness instruments across 24 selected Primary Health Care (PHC) facilities in Plateau State. The collated data were used to estimate the direct medical and non-medical costs incurred by patients through the summation of the various costs paid out of pocket for the services; while the indirect cost was estimated using the human capital theory. All analyses were conducted through Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS®) version 23 software. RESULTS The average direct cost per episode of uncomplicated malaria was estimated at NGN 2808.37/USD 7.39, while the indirect average money equivalence of the time lost due to the ailment was estimated at NGN 2717/USD 7.55, giving an average cost of treating uncomplicated malaria borne by patients in Plateau State per episode to be NGN 5525.37/USD 14.94. The projected annual cost of the disease was NGN 9, 921,671,307.22 (USD 27, 560,198.08). CONCLUSIONS The study showed substantial financial costs borne by patients due to uncomplicated malaria in Plateau State, comprising 50.83% of direct cost and 49.17% of the indirect cost of medications.
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Affiliation(s)
- Nahlah Elkudssiah Ismail
- Malaysian Academy of Pharmacy, Puchong 47160, Malaysia
- Faculty of Pharmacy, MAHSA University, Jenjarom 42610, Malaysia
| | - Nanloh Samuel Jimam
- Faculty of Pharmacy, MAHSA University, Jenjarom 42610, Malaysia
- Faculty of Pharmaceutical Sciences, University of Jos, Jos 930105, Nigeria
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia
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14
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Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Glob Health Action 2022; 15:2045092. [PMID: 35389331 PMCID: PMC9004491 DOI: 10.1080/16549716.2022.2045092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity. Objective Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer. Methods Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease’s total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020. Results The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million. Conclusion This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.
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Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Ciaran Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kazemi Z, Emamgholipour Sefiddashti S, Daroudi R, Ghorbani A, Yunesian M, Hassanvand MS, Shahali Z. Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals. BMJ Open 2022; 12:e067573. [PMID: 36523213 PMCID: PMC9748924 DOI: 10.1136/bmjopen-2022-067573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals. SETTING Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation. DESIGN This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke. PARTICIPANTS A total of 19 150 patients suffering from stroke were studied. RESULTS Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91±974.44 (mean±SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18±37.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged ≤49 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95% CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke's expenses and mortality rates. CONCLUSION Applying cost-effective stroke prevention strategies among the younger population (≤49 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.
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Affiliation(s)
- Zohreh Kazemi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | | | - Rajabali Daroudi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Askar Ghorbani
- Department of Neurology, Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
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Masis L, Kanya L, Kiogora J, Kiapi L, Tulloch C, Alani AH. Estimating treatment costs for uncomplicated diabetes at a hospital serving refugees in Kenya. PLoS One 2022; 17:e0276702. [PMID: 36288390 PMCID: PMC9604983 DOI: 10.1371/journal.pone.0276702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation, $1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost $91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders.
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Affiliation(s)
- Lizah Masis
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Lucy Kanya
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | | | - Lilian Kiapi
- International Rescue Committee, London, United Kingdom
| | - Caitlin Tulloch
- International Rescue Committee, New York City, NY, United States of America
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Mattiello RMA, Pazin-Filho A, Aragon DC, Cupo P, Carlotti APDCP. Impact of children with complex chronic conditions on costs in a tertiary referral hospital. Rev Saude Publica 2022; 56:89. [PMID: 36259914 PMCID: PMC9550162 DOI: 10.11606/s1518-8787.2022056004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil. METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year. RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients’ complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95). CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.
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Affiliation(s)
- Regina Maria Antunes Mattiello
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDepartamento de Puericultura e PediatriaRibeirão PretoSPBrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Puericultura e Pediatria. Ribeirão Preto, SP, Brasil
| | - Antonio Pazin-Filho
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDepartamento de Clínica MédicaRibeirão PretoSPBrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Clínica Médica. Ribeirão Preto, SP, Brasil
| | - Davi Casale Aragon
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDepartamento de Puericultura e PediatriaRibeirão PretoSPBrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Puericultura e Pediatria. Ribeirão Preto, SP, Brasil
| | - Palmira Cupo
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDepartamento de Puericultura e PediatriaRibeirão PretoSPBrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Puericultura e Pediatria. Ribeirão Preto, SP, Brasil
| | - Ana Paula de Carvalho Panzeri Carlotti
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDepartamento de Puericultura e PediatriaRibeirão PretoSPBrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Puericultura e Pediatria. Ribeirão Preto, SP, Brasil
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18
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Kühl MJ, Gondwe T, Dhabangi A, Kwambai TK, Mori AT, Opoka R, John CC, Idro R, ter Kuile FO, Phiri KS, Robberstad B. Economic evaluation of postdischarge malaria chemoprevention in preschool children treated for severe anaemia in Malawi, Kenya, and Uganda: A cost-effectiveness analysis. EClinicalMedicine 2022; 52:101669. [PMID: 36313146 PMCID: PMC9596312 DOI: 10.1016/j.eclinm.2022.101669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children hospitalised with severe anaemia in malaria-endemic areas are at a high risk of dying or being readmitted within six months of discharge. A trial in Kenya and Uganda showed that three months of postdischarge malaria chemoprevention (PDMC) with monthly dihydroartemisinin-piperaquine (DP) substantially reduced this risk. The World Health Organization recently included PDMC in its malaria chemoprevention guidelines. We conducted a cost-effectiveness analysis of community-based PDMC delivery (supplying all three PDMC-DP courses to caregivers at discharge to administer at home), facility-based PDMC delivery (monthly dispensing of PDMC-DP at the hospital), and the standard of care (no PDMC). METHODS We combined data from two recently completed trials; one placebo-controlled trial in Kenya and Uganda collecting efficacy data (May 6, 2016 until November 15, 2018; n=1049), and one delivery mechanism trial from Malawi collecting adherence data (March 24, 2016 until October 3, 2018; n=375). Cost data were collected alongside both trials. Three Markov decision models, one each for Malawi, Kenya, and Uganda, were used to compute incremental cost-effectiveness ratios expressed as costs per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty. FINDINGS Both PDMC strategies were cost-saving in each country, meaning less costly and more effective in increasing health-adjusted life expectancy than the standard of care. The estimated incremental cost savings for community-based PDMC compared to the standard of care were US$ 22·10 (Malawi), 38·52 (Kenya), and 26·23 (Uganda) per child treated. The incremental effectiveness gain using either PDMC strategy varied between 0·3 and 0·4 QALYs. Community-based PDMC was less costly and more effective than facility-based PDMC. These results remained robust in sensitivity analyses. INTERPRETATION PDMC under implementation conditions is cost-saving. Caregivers receiving PDMC at discharge is a cost-effective delivery strategy for implementation in malaria-endemic southeastern African settings. FUNDING Research Council of Norway.
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Affiliation(s)
- Melf-Jakob Kühl
- Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
- Health Economics Leadership and Translational Ethics Research Group (HELTER), Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Thandile Gondwe
- Kamuzu University of Health Sciences, 782 Mahatma Gandhi, Blantyre, Malawi
- Training and Research Unit of Excellence, 1 Kufa Road, Blantyre, Malawi
| | - Aggrey Dhabangi
- Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, Uganda
| | - Titus K. Kwambai
- Centre for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Busia Rd, Kisumu, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool L3 5QA, United Kingdom
| | - Amani T. Mori
- Chr. Michelsen Institute, Jekteviksbakken 31, 5006 Bergen, Norway
- Health Economics Leadership and Translational Ethics Research Group (HELTER), Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Robert Opoka
- Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, Uganda
| | - C. Chandy John
- Ryan White Center for Pediatric Infectious Diseases and Global Health, School of Medicine, Indiana University, 1044 W Walnut St, R4 402D Indianapolis, United States of America
| | - Richard Idro
- Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, Uganda
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool L3 5QA, United Kingdom
| | - Kamija S. Phiri
- Kamuzu University of Health Sciences, 782 Mahatma Gandhi, Blantyre, Malawi
- Training and Research Unit of Excellence, 1 Kufa Road, Blantyre, Malawi
| | - Bjarne Robberstad
- Health Economics Leadership and Translational Ethics Research Group (HELTER), Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
- Corresponding author at: Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway.
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Fischer C, Mayer S, Perić N, Simon J. Harmonization issues in unit costing of service use for multi-country, multi-sectoral health economic evaluations: a scoping review. HEALTH ECONOMICS REVIEW 2022; 12:42. [PMID: 35920934 PMCID: PMC9347135 DOI: 10.1186/s13561-022-00390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Valuation is a critical part of the costing process in health economic evaluations. However, an overview of specific issues relevant to the European context on harmonizing methodological requirements for the valuation of costs to be used in health economic evaluation is lacking. We aimed to inform the development of an international, harmonized and multi-sectoral costing framework, as sought in the European PECUNIA (ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions) project. METHODS We conducted a scoping review (information extraction 2008-2021) to a) to demonstrate the degree of heterogeneity that currently exists in the literature regarding central terminology, b) to generate an overview of the most relevant areas for harmonization in multi-sectoral and multi-national costing processes for health economic evaluations, and c) to provide insights into country level variation regarding economic evaluation guidance. A complex search strategy was applied covering key publications on costing methods, glossaries, and international costing recommendations augmented by a targeted author and reference search as well as snowballing. Six European countries served as case studies to describe country-specific harmonization issues. Identified information was qualitatively synthesized and cross-checked using a newly developed, pilot-tested data extraction form. RESULTS Costing methods for services were found to be heterogeneous between sectors and country guidelines and may, in practice, be often driven by data availability and reimbursement systems in place. The lack of detailed guidance regarding specific costing methods, recommended data sources, double-counting of costs between sectors, adjustment of unit costs for inflation, transparent handling of overhead costs as well as the unavailability of standardized unit costing estimates in most countries were identified as main drivers of country specific differences in costing methods with a major impact on valuation and cost-effectiveness evidence. CONCLUSION This review provides a basic summary of existing costing practices for evaluative purposes across sectors and countries and highlights several common methodological factors influencing divergence in cost valuation methods that would need to be systematically incorporated and addressed in future costing practices to achieve more comparable, harmonized health economic evaluation evidence.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Nataša Perić
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Okal JO, Awiti JO, Matheka J, Oluoch-Madiang D, Obanda R, Mathur S. Unit costs of a community-based girl-centered HIV prevention program: a case study of Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe program. AIDS 2022; 36:S109-S117. [PMID: 35766580 DOI: 10.1097/qad.0000000000003217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We compare the unit costs of providing Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) interventions to adolescent girls and young women (AGYW) reached across two sites, an urban (Nyalenda A Ward) and peri-urban (Kolwa East Ward) setting, in Kisumu County of Kenya. DESIGN Micro-costing, using the average cost concept during project initiation and early implementation. METHODS Adopting the implementer's (provider's) perspective, we computed and classified costs in the following categories for each sub-implementing partner: medical and professional staff, administrative and support staff, materials and supplies, building space and utilities, equipment, establishment, and miscellaneous. These costs were summed across sub-implementing partners in a site to obtain the site-level total costs. These are then divided by the total number of AGYW reached in each site to obtain the unit costs. Data were collected from July to September 2017. RESULTS The unit costs in the peri-urban area were about 1.9 times of those in the urban area. It cost about US$67 [or 170 International Dollars] to deliver the DREAMS intervention package to each AGYW reached in the urban area as compared with approximately US$129 (or 327 International Dollars) in the peri-urban area. CONCLUSION First, it was generally more expensive to deliver DREAMS interventions in the peri-urban setting as compared with the urban setting. Second, the difference in unit costs was mainly driven by the building space and utilities. Strategies to lower intervention costs are needed in the peri-urban setting, such as using existing infrastructure (either governmental or nongovernmental) or other innovative ways to deliver the services.
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Affiliation(s)
| | | | | | | | - Rael Obanda
- APHIAPlus Western Kenya, PATH, Kisumu, Kenya
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21
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Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: Providing a practical framework for surgeons. Int J Health Plann Manage 2022; 37:1926-1940. [PMID: 35191067 DOI: 10.1002/hpm.3431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/25/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.
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Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni C Athanasiadou
- Surgical Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Andreas I Tooulias
- First General Surgery Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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22
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Sunil VN, Mrunalini K, Prathima V. Cost calculation of a tertiary care referral dental center using activity-based costing method: A case study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Morrison LTR, Brown EG, Paganelli CR, Bhattarai S, Hailu R, Ntakirutimana G, Mbarushimana D, Subedi N, Goco N. Cost Evaluation of Minimally Invasive Tissue Sampling (MITS) Implementation in Low- and Middle-Income Countries. Clin Infect Dis 2021; 73:S401-S407. [PMID: 34910172 PMCID: PMC8672771 DOI: 10.1093/cid/ciab828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) face disproportionately high mortality rates, yet the causes of death in LMICs are not robustly understood, limiting the effectiveness of interventions to reduce mortality. Minimally invasive tissue sampling (MITS) is a standardized postmortem examination method that holds promise for use in LMICs, where other approaches for determining cause of death are too costly or unacceptable. This study documents the costs associated with implementing the MITS procedure in LMICs from the healthcare provider perspective and aims to inform resource allocation decisions by public health decisionmakers. Methods We surveyed 4 sites in LMICs across Sub-Saharan Africa and South Asia with experience conducting MITS. Using a bottom-up costing approach, we collected direct costs of resources (labor and materials) to conduct MITS and the pre-implementation costs required to initiate MITS. Results Initial investments range widely yet represent a substantial cost to implement MITS and are determined by the existing infrastructure and needs of a site. The costs to conduct a single case range between $609 and $1028 per case and are driven by labor, sample testing, and MITS supplies costs. Conclusions Variation in each site’s use of staff roles and testing protocols suggests sites conducting MITS may adapt use of resources based on available expertise, equipment, and surveillance objectives. This study is a first step toward necessary examinations of cost-effectiveness, which may provide insight into cost optimization and economic justification for the expansion of MITS.
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Affiliation(s)
| | | | | | - Suraj Bhattarai
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Rahell Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Djibril Mbarushimana
- Kigali University Teaching Hospital, Kigali, Rwanda.,University Teaching Hospital of Butare, Huye, Rwanda
| | - Nuwadatta Subedi
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Norman Goco
- RTI International, Durham, North Carolina, USA
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Galactionova K, Sahu M, Gideon SP, Puthupalayam Kaliappan S, Morozoff C, Ajjampur SSR, Walson J, Rubin Means A, Tediosi F. Costing interventions in the field: preliminary cost estimates and lessons learned from an evaluation of community-wide mass drug administration for elimination of soil-transmitted helminths in the DeWorm3 trial. BMJ Open 2021; 11:e049734. [PMID: 34226233 PMCID: PMC8258667 DOI: 10.1136/bmjopen-2021-049734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To present a costing study integrated within the DeWorm3 multi-country field trial of community-wide mass drug administration (cMDA) for elimination of soil-transmitted helminths. DESIGN Tailored data collection instruments covering resource use, expenditure and operational details were developed for each site. These were populated alongside field activities by on-site staff. Data quality control and validation processes were established. Programmed routines were used to clean, standardise and analyse data to derive costs of cMDA and supportive activities. SETTING Field site and collaborating research institutions. PRIMARY AND SECONDARY OUTCOME MEASURES A strategy for costing interventions in parallel with field activities was discussed. Interim estimates of cMDA costs obtained with the strategy were presented for one of the trial sites. RESULTS The study demonstrated that it was both feasible and advantageous to collect data alongside field activities. Practical decisions on implementing the strategy and the trade-offs involved varied by site; trialists and local partners were key to tailoring data collection to the technical and operational realities in the field. The strategy capitalised on the established processes for routine financial reporting at sites, benefitted from high recall and gathered operational insight that facilitated interpretation of the estimates derived. The methodology produced granular costs that aligned with the literature and allowed exploration of relevant scenarios. In the first year of the trial, net of drugs, the incremental financial cost of extending deworming of school-aged children to the whole community in India site averaged US$1.14 (USD, 2018) per person per round. A hypothesised at-scale routine implementation scenario yielded a much lower estimate of US$0.11 per person treated per round. CONCLUSIONS We showed that costing interventions alongside field activities offers unique opportunities for collecting rich data to inform policy toward optimising health interventions and for facilitating transfer of economic evidence from the field to the programme. TRIAL REGISTRATION NUMBER NCT03014167; Pre-results.
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Affiliation(s)
- Katya Galactionova
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maitreyi Sahu
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Samuel Paul Gideon
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Chloe Morozoff
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sitara Swarna Rao Ajjampur
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Nguyen TT, Hajeebhoy N, Li J, Do CT, Mathisen R, Frongillo EA. Community support model on breastfeeding and complementary feeding practices in remote areas in Vietnam: implementation, cost, and effectiveness. Int J Equity Health 2021; 20:121. [PMID: 34001154 PMCID: PMC8127246 DOI: 10.1186/s12939-021-01451-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Poor access to healthcare facilities and consequently nutrition counseling services hinders the uptake of recommended infant and young child feeding (IYCF) practices. To address these barriers and improve IYCF practices, Alive & Thrive (A&T) initiated community support groups in remote villages across nine provinces in Vietnam. Objective This study examines the effectiveness of the support group model and related project costs for reaching underserved areas to improve IYCF practices. Methods To evaluate the model’s implementation and project costs, we reviewed implementation guidelines, expenditure and coverage reports, monitoring data, and budgets for the nine provinces. To evaluate the model’s effectiveness, we used a 3-stage sampling method to conduct a cross-sectional survey from April to May 2014 in three provinces entailing interviewing mothers of children aged 0–23 months in communes with (intervention; n = 551) and without support groups (comparison; n = 559). Findings Coverage: From November 2011 to November 2014, in partnership with the government, A&T supported training for 1513 facilitators and the establishing 801 IYCF support groups in 267 villages across nine provinces. During this period, facilitators provided ~ 166,000 meeting/support contacts with ~ 33,000 pregnant women and mothers with children aged 0–23 months in intervention villages. Costs: The average project costs for supporting the meetings, compensating village collaborators, and providing supportive supervision through staff in commune health stations were USD 5 per client and USD 1 per contact. After adding expenditures for training, supportive supervision, and additional administrative costs at central and provincial levels, the average project cost was USD 15 per client and USD 3 per contact. Effectiveness: Survey participants in intervention and comparison communes had similar maternal, child, and household characteristics. Multiple logistic regression models showed that living in intervention communes was associated with higher odds of early initiation of breastfeeding (OR: 1.7; 95% CI: 1.1, 2.7), exclusive breastfeeding from 0 to 5 months (OR: 12.5; 95% CI: 6.7, 23.4), no bottle feeding (OR: 2.69; 95% CI: 1.82, 3.99), and minimum acceptable diet (OR: 1.51; 95% CI: 0.98, 2.33) compared to those living in comparison communes. Conclusion The IYCF support group model was effective in reaching populations residing in remote areas and likely contributed to improved IYCF practices. The study suggests that the model could be scaled up to promote equity in breastfeeding support. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01451-0.
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Affiliation(s)
| | - Nemat Hajeebhoy
- Alive & Thrive, FHI 360, Hanoi, Vietnam.,Nutrition Section, UNICEF Nigeria, Abuja, Nigeria
| | - Jia Li
- School of Business, Nanjing University of Information Science & Technology, Nanjing, China
| | | | | | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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26
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Smith S, Jiang J, Normand C, O’Neill C. Unit costs for non-acute care in Ireland 2016—2019. HRB Open Res 2021; 4:39. [PMID: 35317302 PMCID: PMC8917322 DOI: 10.12688/hrbopenres.13256.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background: This paper presents detailed unit costs for 16 healthcare professionals in community-based non-acute services in Ireland for the years 2016—2019. Unit costs are important data inputs for assessments of health service performance and value for money. Internationally, while some countries have an established database of unit costs for healthcare, there is need for a more coordinated approach to calculating healthcare unit costs. In Ireland, detailed cost analysis of acute care is undertaken by the Healthcare Pricing Office but to date there has been no central database of unit costs for community-based non-acute healthcare services. Methods: Unit costs for publicly employed allied healthcare professionals, Public Health Nurses and Health Care Assistant staff are calculated using a bottom-up micro-costing approach, drawing on methods outlined by the Personal Social Services Research Unit in the UK, and on available Irish and international costing guidelines. Data on salaries, working hours and other parameters are drawn from secondary datasets available from Department of Health, Health Service Executive and other public sources. Unit costs for public and private General Practitioner, dental, and long-term residential care (LTRC) are estimated drawing on available administrative and survey data. Results: The unit costs for the publicly employed non-acute healthcare professionals have changed by 2–6% over the timeframe 2016–2019 while larger percentage changes are observed in the unit costs for public GP visits and public LTRC (14-15%). Conclusions: The costs presented here are a first step towards establishing a central database of unit costs for non-acute healthcare services in Ireland. The database will help ensure consistency across Irish health costing studies and facilitate cross-study and cross-country comparisons. Future work will be required to update and expand on the range of services covered and to incorporate new data and methodological developments in cost estimation as they become available.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Jingjing Jiang
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute, London, SE5 9PJ, UK
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BA, Ireland
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Werner K, Lin TK, Risko N, Osiro M, Kalanzi J, Wallis L. The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study. BMC Health Serv Res 2021; 21:232. [PMID: 33726738 PMCID: PMC7961167 DOI: 10.1186/s12913-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions. METHODS A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions. RESULTS Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05). CONCLUSION This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.
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Affiliation(s)
- Kalin Werner
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa.
| | - Tracy Kuo Lin
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Risko
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martha Osiro
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa
| | | | - Lee Wallis
- Division of Emergency Medicine, University of Cape, Cape Town, South Africa
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Aminde LN, Dzudie A, Mapoure YN, Tantchou JC, Veerman JL. Estimation and determinants of direct medical costs of ischaemic heart disease, stroke and hypertensive heart disease: evidence from two major hospitals in Cameroon. BMC Health Serv Res 2021; 21:140. [PMID: 33579273 PMCID: PMC7881453 DOI: 10.1186/s12913-021-06146-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the largest contributor to the non-communicable diseases (NCD) burden in Cameroon, but data on its economic burden is lacking. Methods A prevalence-based cost-of-illness study was conducted from a healthcare provider perspective and enrolled patients with ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke and hypertensive heart disease (HHD) from two major hospitals between 2013 and 2017. Determinants of cost were explored using multivariate generalized linear models. Results Overall, data from 850 patients: IHD (n = 92, 10.8%), ischaemic stroke (n = 317, 37.3%), haemorrhagic stroke (n = 193, 22.7%) and HHD (n = 248, 29.2%) were analysed. The total cost for these CVDs was XAF 676,694,000 (~US$ 1,224,918). The average annual direct medical costs of care per patient were XAF 1,395,200 (US$ 2400) for IHD, XAF 932,700 (US$ 1600) for ischaemic stroke, XAF 815,400 (US$ 1400) for haemorrhagic stroke, and XAF 384,300 (US$ 700) for HHD. In the fully adjusted models, apart from history of CVD event (β = − 0.429; 95% confidence interval − 0.705, − 0.153) that predicted lower costs in patients with IHD, having of diabetes mellitus predicted higher costs in patients with IHD (β = 0.435; 0.098, 0.772), ischaemic stroke (β = 0.188; 0.052, 0.324) and HHD (β = 0.229; 0.080, 0.378). Conclusions This study reveals substantial economic burden due to CVD in Cameroon. Diabetes mellitus was a consistent driver of elevated costs across the CVDs. There is urgent need to invest in cost-effective primary prevention strategies in order to reduce the incidence of CVD and consequent economic burden on a health system already laden with the impact of communicable diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06146-4.
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Affiliation(s)
- Leopold Ndemnge Aminde
- School of Medicine, Griffith University, Gold Coast, Australia. .,Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.
| | - Anastase Dzudie
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine, University of Yaounde 1, Yaounde, Cameroon
| | - Yacouba N Mapoure
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine & Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Muniyandi M, Lavanya J, Karikalan N, Saravanan B, Senthil S, Selvaraju S, Mondal R. Estimating TB diagnostic costs incurred under the National Tuberculosis Elimination Programme: a costing study from Tamil Nadu, South India. Int Health 2021; 13:536-544. [PMID: 33570132 PMCID: PMC8643484 DOI: 10.1093/inthealth/ihaa105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background The National Tuberculosis Elimination Programme (NTEP) of India is aiming to eliminate TB by 2025. The programme has increased its services and resources to strengthen the accurate and early detection of TB. It is important to estimate the cost of TB diagnosis in India considering the advancement and implementation of new diagnostic tools under the NTEP. The objective of this study was to estimate the unit costs of providing TB diagnostic services at different levels of public health facilities with different algorithms implemented under the NTEP in Chennai, Tamil Nadu, South India. Methods This costing study was conducted from the perspective of the health system. This study used only secondary data and information that were available in the public domain. Data were collected with the approval of health authorities. The patient's diagnostic path from the point of registration until the final diagnosis was considered in the costing exercise. The unit costs of different diagnostic tools used in the NTEP implemented by Chennai Corporation were calculated. Results We estimated the unit cost of the eight laboratory tests (Ziehl–Neelsen [ZN], fluorescence microscopy [FM], x-ray, digital x-ray, gene Xpert MTB/RIF (cartridge-based nucleic acid amplification test [NAAT] that identifies rifampicin resistant Mycobacterium Tuberculosis) Mycobacterium Tuberculosis/Rifampicin [MTB/RIF], mycobacteria growth indicator tube [MGIT], line probe assay [LPA] and Lowenstein Jensen [LJ] culture) for diagnosis of drug-sensitive and drug-resistant TB. The unit costs included fixed and variable costs for smear examination by ZN microscopy (₹ [Indian Rupee] 326 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}4.72], FM (₹104 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}1.5]), x-ray (₹218 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}3.15]), digital X-ray (₹281 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}4.07]), gene Xpert MTB/RIF (₹1137 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}16.47]), MGIT (₹7038 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}102]), LPA (₹6448 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}93.44]) and LJ culture (₹4850 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}70.28]). Out of 10 diagnostic algorithms used for TB diagnosis, algorithms using only smear microscopy had the lowest cost, followed by smear microscopy with x-ray for drug-sensitive TB (₹104 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}1.5] to ₹544 [US\documentclass[12pt]{minimal}
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}{}${\$}$\end{document}7.88]). Diagnostic algorithms for drug-resistant TB involving LPA and gene Xpert MTB/RIF were the most expensive. Conclusions Understanding the various costs contributing to TB diagnosis in India provides crucial evidence for policymakers, programme managers and researchers to optimise programme spending and efficiently use resources.
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Affiliation(s)
| | - Jayabal Lavanya
- District TB Office, National TB Elimination Programme, Chennai
| | - Nagarajan Karikalan
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Balakrishnan Saravanan
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Sellappan Senthil
- Department ofHealthEconomics, ICMR-National Institute for Research in Tuberculosis, Chennai-600031, India
| | - Sriram Selvaraju
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai
| | - Rajesh Mondal
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai
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The cost of inpatient burn management in Nepal. Burns 2021; 47:1675-1682. [PMID: 33947601 DOI: 10.1016/j.burns.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal. METHODS We conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting. RESULTS Experts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A 'typical' burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively. CONCLUSION This study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.
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Carvalho JDP, de Assis TM, Simões TC, Cota G. Estimating direct costs of the treatment for mucosal leishmaniasis in Brazil. Rev Soc Bras Med Trop 2021; 54:e04542020. [PMID: 33533816 PMCID: PMC7849328 DOI: 10.1590/0037-8682-0454-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION The objective of this study was to estimate the direct medical costs of the treatment for mucosal leishmaniasis (ML) using three therapeutic approaches in the Brazilian context. METHODS We performed this economic assessment from the perspective of the Brazilian public healthcare system. The following therapeutic approaches were evaluated: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Direct medical costs were estimated considering four treatment components: a) drug, b) combined medical products, c) procedures, and d) complementary tests. RESULTS Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen. The average cost of treatment with liposomal amphotericin B was US$ 715.35 both in inpatient regimen. In all estimates, the drugs accounted for more than 60% of the total cost for each treatment approach. CONCLUSIONS These results demonstrate the marked differences in costs between the therapeutic alternatives for ML. In addition to efficacy rates and costs related to adverse events, our data have the potential to support a complete cost-effectiveness study in the future. Complete analyses comparing costs and benefits for interventions will assist health managers in choosing drugs for ML treatment in Brazil as well as in establishing effective public health policies.
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Affiliation(s)
- Janaína de Pina Carvalho
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
- Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Contagem, MG, Brasil
| | - Taynãna César Simões
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
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Glaeser E, Jacobs B, Appelt B, Engelking E, Por I, Yem K, Flessa S. Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia-A Prerequisite for Efficient and Fair Comprehensive Obstetric Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8085. [PMID: 33147862 PMCID: PMC7663741 DOI: 10.3390/ijerph17218085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022]
Abstract
Knowing the cost of health care services is a prerequisite for evidence-based management and decision making. However, only limited costing data is available in many low- and middle-income countries. With a substantially increasing number of facility-based births in Cambodia, costing data for efficient and fair resource allocation is required. This paper evaluates the costs for cesarean section (CS) at a public and a Non-Governmental (NGO) hospital in Cambodia in the year 2018. We performed a full and a marginal cost analysis, i.e., we developed a cost function and calculated the respective unit costs from the provider's perspective. We distinguished fixed, step-fixed, and variable costs and followed an activity-based costing approach. The processes were determined by personal observation of CS-patients and all procedures; the resource consumption was calculated based on the existing accounting documentation, observations, and time-studies. Afterwards, we did a comparative analysis between the two hospitals and performed a sensitivity analysis, i.e., parameters were changed to cater for uncertainty. The public hospital performed 54 monthly CS with an average length of stay (ALOS) of 7.4 days, compared to 18 monthly CS with an ALOS of 3.4 days at the NGO hospital. Staff members at the NGO hospital invest more time per patient. The cost per CS at the current patient numbers is US$470.03 at the public and US$683.23 at the NGO hospital. However, the unit cost at the NGO hospital would be less than at the public hospital if the patient numbers were the same. The study provides detailed costing data to inform decisionmakers and can be seen as a steppingstone for further costing exercises.
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Affiliation(s)
- Eva Glaeser
- Department of General Business Administration and Health Care Management, University of Greifswald, 17489 Greifswald, Germany;
| | - Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Bernd Appelt
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Elias Engelking
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Ir Por
- National Institute of Public Health (NIPH), Phnom Penh 12150, Cambodia; (I.P.); (K.Y.)
| | - Kunthea Yem
- National Institute of Public Health (NIPH), Phnom Penh 12150, Cambodia; (I.P.); (K.Y.)
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, 17489 Greifswald, Germany;
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Kuwawenaruwa A, Wyss K, Wiedenmayer K, Tediosi F. Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania. BMJ Glob Health 2020; 5:bmjgh-2020-002681. [PMID: 32928801 PMCID: PMC7490950 DOI: 10.1136/bmjgh-2020-002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/24/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Economic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as ‘Jazia Prime Vendor System’ (Jazia PVS)). Methods Financial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014–July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018–2019). A multivariate sensitivity analysis was conducted on the estimates. Results Jazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37. Conclusion In conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities.
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Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .,University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Kaspar Wyss
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Karin Wiedenmayer
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Health Promotion and System Strengthening (HPSS) project, Dodoma, United Republic of Tanzania
| | - Fabrizio Tediosi
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
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Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia. BIOMÉDICA 2020; 40:270-282. [PMID: 32673456 PMCID: PMC7505512 DOI: 10.7705/biomedica.4658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 12/04/2022]
Abstract
Introducción. Las enfermedades transmitidas por Aedes aegypti son un problema de salud pública. VECTOS es un programa novedoso de integración de estrategias de control de vectores. Objetivo. Evaluar el costo-efectividad del uso del VECTOS en los programas de control rutinario de enfermedades transmitidas por el vector Aedes aegypti en el municipio de San Juan de Girón (Santander). Materiales y métodos. Se evaluó el costo-efectividad del programa empleando un modelo de análisis de decisiones desde la perspectiva de las autoridades locales de salud. Se estudió la integración de las estrategias de control de vectores mediante el programa VECTOS utilizado en el municipio de San Juan de Girón durante el 2016, con el control rutinario llevado a cabo sin VECTOS en el municipio de Floridablanca. Se calculó la razón incremental del costo-efectividad (RICE), usando como medida de efectividad los años de vida ajustados por discapacidad (AVAD). Resultados. El uso del programa VECTOS fue rentable a una tasa de ahorro de USD$ 660,4 por cada AVAD evitado en comparación con el control de rutina en Floridablanca. El modelo probabilístico indicó que el sistema fue costo-efectivo en el 70 % de las 10.000 iteraciones para un umbral entre 1 y 3 PIB per cápita. Conclusiones. El programa VECTOS fue muy costo-efectivo en el municipio de San Juan de Girón. Su uso puede adoptarse en otros municipios del país donde las enfermedades transmitidas por A. aegypti son endémicas.
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Anderson DM, Cronk R, Best L, Radin M, Schram H, Tracy JW, Bartram J. Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2075. [PMID: 32245057 PMCID: PMC7143484 DOI: 10.3390/ijerph17062075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.
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Affiliation(s)
- Darcy M. Anderson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - Lucy Best
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - Mark Radin
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - Hayley Schram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - J. Wren Tracy
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (R.C.); (L.B.); (M.R.); (H.S.); (J.W.T.); (J.B.)
- School of Civil Engineering, University of Leeds, Leeds LS2 9JT, UK
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Madan JJ, Rosu L, Tefera MG, van Rensburg C, Evans D, Langley I, Tomeny EM, Nunn A, Phillips PP, Rusen ID, Squire SB. Economic evaluation of short treatment for multidrug-resistant tuberculosis, Ethiopia and South Africa: the STREAM trial. Bull World Health Organ 2020; 98:306-314. [PMID: 32514196 PMCID: PMC7265936 DOI: 10.2471/blt.19.243584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis. Methods We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up and top-down approaches. A cost–effectiveness analysis was performed by calculating the incremental cost per unfavourable outcome avoided. Findings Health-care costs per participant in South Africa were 8340.7 United States dollars (US$) with the long and US$ 6618.0 with the short regimen; in Ethiopia, they were US$ 6096.6 and US$ 4552.3, respectively. The largest component of the saving was medication costs in South Africa (67%; US$ 1157.0 of total US$ 1722.8) and social support costs in Ethiopia (35%, US$ 545.2 of total US$ 1544.3). In Ethiopia, trial participants on the short regimen reported lower expenditure for supplementary food (mean reduction per participant: US$ 225.5) and increased working hours (i.e. 667 additional hours over 132 weeks). The probability that the short regimen was cost–effective was greater than 95% when the value placed on avoiding an unfavourable outcome was less than US$ 19 000 in Ethiopia and less than US$ 14 500 in South Africa. Conclusion The short MDR tuberculosis treatment regimen was associated with a substantial reduction in health-system costs and a lower financial burden for participants.
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Affiliation(s)
- Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, England
| | - Laura Rosu
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Mamo Girma Tefera
- Department of Business Management, Addis Ababa Science & Technology University, Addis Ababa, Ethiopia
| | - Craig van Rensburg
- Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa
| | - Ivor Langley
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Ewan M Tomeny
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Andrew Nunn
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, London, England
| | - Patrick Pj Phillips
- Department of Medicine, University of California San Francisco, San Francisco, United States of America (USA)
| | - I D Rusen
- Division of Research and Development, Vital Strategies, New York, USA
| | - S Bertel Squire
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
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Diestro JDB, Omar AT, Sarmiento RJC, Enriquez CAG, Castillo LLCD, Ho BL, Khu KJOL, Pascual V JLR. Cost of hospitalization for stroke in a low–middle-income country: Findings from a public tertiary hospital in the Philippines. Int J Stroke 2020; 16:39-42. [DOI: 10.1177/1747493020906872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Determining the cost of hospitalization for acute stroke is important in the appropriate allocation of resources for public health facilities and in the cost effectiveness analysis of interventions. Despite being the second leading cause of mortality in the Philippines, there are no published data on the cost of stroke in the country. Aim The study aims to determine the in-hospitalization cost for stroke (IHCS) in a tertiary public hospital in the Philippines and identify the factors influencing IHCS. Methods The study was a retrospective review of the medical and billing records of the hospital. Adult patients admitted for acute stroke between 1 June 2017 and 31 May 2018 were included in the analysis. After the mean cost of stroke was determined, multivariate logistic regression analysis was done to determine demographic and clinical characteristics that were predictive of stroke cost. Results A total of 863 patient records were analyzed. The median in-hospitalization cost for stroke was PHP 17,141.50 or US$329.52. Independent determinants of higher cost include male sex (p = 0.021), stroke type (hemorrhagic stroke, p = 0.001; subarachnoid hemorrhage, p < 0.001), lower GCS on admission (p = 0.023), surgical intervention (p < 0.001), intravenous thrombolysis (p < 0.001), infection (p < 0.001), length of hospital stay (p < 0.001), and mechanical ventilation (p = 0.008). Conclusion The study provided current data on the in-hospitalization cost of acute stroke in a public tertiary hospital in the Philippines. Male sex, stroke type, lower GCS on admission, surgical intervention, intravenous thrombolysis, infection, length of hospital stay, and mechanical ventilation were independent predictors of cost.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Abdelsimar Tan Omar
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Robert Joseph Cruz Sarmiento
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Clare Angeli Guinto Enriquez
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Lennie Lynn Chua-De Castillo
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Beverly Lorraine Ho
- Research Division, Health Policy Development and Planning Bureau, Department of Health, Manila, Philippines
| | - Kathleen Joy Ong Lopez Khu
- Section of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Leonard Rivera Pascual V
- Section of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Lam CK, Fluegge K, Macaraig M, Burzynski J. Cost savings associated with video directly observed therapy for treatment of tuberculosis. Int J Tuberc Lung Dis 2019; 23:1149-1154. [PMID: 31718750 DOI: 10.5588/ijtld.18.0625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To calculate the per-session and annual direct program costs to implement directly observed therapy (DOT) for tuberculosis treatment and to conduct a cost attribution analysis under varying proportions of DOT utilization for four DOT types.DESIGN: Program data covering the study period from September 2014 to August 2015 in New York City (NYC) were used to conduct a retrospective bottom-up micro-costing economic evaluation. For each DOT type, potential per-session and annual program savings were estimated as the cost averted by adopting a uniform distribution of DOT alternatives. Sensitivity analyses explored aggregate cost impacts of unequal distributions.RESULTS: There was a total of 38 035 unique DOT visits, of which 12 002 (32%) were clinic-based (CDOT); 15 483 (41%) were field-based (FDOT); 7185 (19%) were live-video (LVDOT); and 3365 (9%) were recorded-video (RVDOT). The per-session direct costs (in 2016 $US) for DOT services delivered during the study period were $8.46 for CDOT; $19.83 for FDOT; $6.54 for LVDOT; and $5.35 for RVDOT. Sensitivity analyses supported the main findings.CONCLUSIONS: Significant cost savings were estimated with increased utilization of VDOT. Assuming equivalent treatment adherence, duration, completion, and adverse events across DOT types, RVDOT was the modality that most minimized cost.
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Affiliation(s)
- C K Lam
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - K Fluegge
- Policy, Planning and Strategic Data Use, Office of the First Deputy Commissioner, New York City Department of Health and Mental Hygiene, Queens, NY, Institute of Health and Environmental Research, Cleveland, OH, USA
| | - M Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - J Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
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Sosa-Hernández O, Matías-Téllez B, Estrada-Hernández A, Cureño-Díaz MA, Bello-López JM. Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in Mexico. Am J Infect Control 2019; 47:e21-e25. [PMID: 30981442 DOI: 10.1016/j.ajic.2019.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48 hours of endotracheal intubation and initiation of mechanical ventilation. The aim of this work was to use a micro-costing method to calculate the costs generated in 2017 for the care of patients with VAP at the Hospital Juárez de México. METHODS We performed a cross-sectional, retrospective, analytical, and observational study of the databases of the registry of health care-associated infections (HAIs) in 2017, in addition to a micro-costing study. RESULTS We studied 48 VAP cases in an adult intensive care unit (AICU). In this period, 1668 ventilator days were identified, with an incidence rate of 28.8 per 1000 days. All cases were caused by multidrug-resistant (MDR) bacteria and the costs of their care exceeded the average costs for the use of antimicrobials. By calculating the profit on return as an association measure, we found that VAP caused by MDR bacteria confers 9 times the risk of increasing the costs of care above the expected average. CONCLUSIONS The cost for a case of VAP in the AICU is high and has an impact on the institutional budget. Control measures to prevent the spread of bacteria, particularly MDR bacteria, must be put into place in order to avoid increases in hospital stay costs and mortality.
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Bijlmakers L, Cornelissen D, Cheelo M, Nthele M, Kachimba J, Broekhuizen H, Gajewski J, Brugha R. The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia. Health Policy Plan 2019; 33:1055-1064. [PMID: 30403781 DOI: 10.1093/heapol/czy086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 12/21/2022] Open
Abstract
The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery.
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Affiliation(s)
- Leon Bijlmakers
- Radboudumc, Department for Health Evidence, Radboud Institute of Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Dennis Cornelissen
- Maastricht University, Department of Health Services Research, 6200 MD Maastricht, The Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Mzaza Nthele
- Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - John Kachimba
- Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - Henk Broekhuizen
- Radboudumc, Department for Health Evidence, Radboud Institute of Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Jakub Gajewski
- Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
| | - Ruairí Brugha
- Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
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Ponatshego PL, Lawrence DS, Youssouf N, Molloy SF, Alufandika M, Bango F, Boulware DR, Chawinga C, Dziwani E, Gondwe E, Hlupeni A, Hosseinipour MC, Kanyama C, Meya DB, Mosepele M, Muthoga C, Muzoora CK, Mwandumba H, Ndhlovu CE, Rajasingham R, Sayed S, Shamu S, Tsholo K, Tugume L, Williams D, Maheswaran H, Shiri T, Boyer-Chammard T, Loyse A, Chen T, Wang D, Lortholary O, Lalloo DG, Meintjes G, Jaffar S, Harrison TS, Jarvis JN, Niessen LW. AMBIsome Therapy Induction OptimisatioN (AMBITION): High dose AmBisome for cryptococcal meningitis induction therapy in sub-Saharan Africa: economic evaluation protocol for a randomised controlled trial-based equivalence study. BMJ Open 2019; 9:e026288. [PMID: 30940760 PMCID: PMC6500286 DOI: 10.1136/bmjopen-2018-026288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cryptococcal meningitis is responsible for around 15% of all HIV-related deaths globally. Conventional treatment courses with amphotericin B require prolonged hospitalisation and are associated with multiple toxicities and poor outcomes. A phase II study has shown that a single high dose of liposomal amphotericin may be comparable to standard treatment. We propose a phase III clinical endpoint trial comparing single, high-dose liposomal amphotericin with the WHO recommended first-line treatment at six sites across five counties. An economic analysis is essential to support wide-scale implementation. METHODS AND ANALYSIS Country-specific economic evaluation tools will be developed across the five country settings. Details of patient and household out-of-pocket expenses and any catastrophic healthcare expenditure incurred will be collected via interviews from trial patients. Health service patient costs and related household expenditure in both arms will be compared over the trial period in a probabilistic approach, using Monte Carlo bootstrapping methods. Costing information and number of life-years survived will be used as the input to a decision-analytic model to assess the cost-effectiveness of a single, high-dose liposomal amphotericin to the standard treatment. In addition, these results will be compared with a historical cohort from another clinical trial. ETHICS AND DISSEMINATION The AMBIsome Therapy Induction OptimisatioN (AMBITION) trial has been evaluated and approved by the London School of Hygiene and Tropical Medicine, University of Botswana, Malawi National Health Sciences, University of Cape Town, Mulago Hospital and Zimbabwe Medical Research Council research ethics committees. All participants will provide written informed consent or if lacking capacity will have consent provided by a proxy. The findings of this economic analysis, part of the AMBITION trial, will be disseminated through peer-reviewed publications and at international and country-level policy meetings. TRIAL REGISTRATION ISRCTN 7250 9687; Pre-results.
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Affiliation(s)
| | - David Stephen Lawrence
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Nabila Youssouf
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sile F Molloy
- Research Centre for Infection and Immunity, St. George's University of London, London, UK
| | - Melanie Alufandika
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
| | - Funeka Bango
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David R Boulware
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Medicine, University of Minnesota, Minnesota, USA
| | | | - Eltas Dziwani
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
| | - Ebbie Gondwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
| | - Admire Hlupeni
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Cecilia Kanyama
- Lilongwe Medical Relief Trust (UNC Project), Lilongwe, Malawi
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Mosepele Mosepele
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Charles Muthoga
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Conrad K Muzoora
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Henry Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Sumaya Sayed
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Shepherd Shamu
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Katlego Tsholo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lillian Tugume
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Darlisha Williams
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Medicine, University of Minnesota, Minnesota, USA
| | - Hendramoorthy Maheswaran
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
- Population Evidence and Technologies, University of Warwick, Coventry, UK
| | - Tinevimbo Shiri
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Timothée Boyer-Chammard
- Molecular Mycology Unit and National Reference Centre for Invasive Mycoses, Institut Pasteur, Paris, France
| | - Angela Loyse
- Research Centre for Infection and Immunity, St. George's University of London, London, UK
| | - Tao Chen
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olivier Lortholary
- Molecular Mycology Unit and National Reference Centre for Invasive Mycoses, Institut Pasteur, Paris, France
| | - David G Lalloo
- Malawi-Liverpool-Wellcome Trust Clinical Research Centre, Blantyre, Malawi
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Graeme Meintjes
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Shabbar Jaffar
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S Harrison
- Research Centre for Infection and Immunity, St. George's University of London, London, UK
| | - Joseph N Jarvis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Louis Wilhelmus Niessen
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Johns B, Hangoma P, Atuyambe L, Faye S, Tumwine M, Zulu C, Levitt M, Tembo T, Healey J, Li R, Mugasha C, Serbanescu F, Conlon CM. The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:S104-S122. [PMID: 30867212 PMCID: PMC6519668 DOI: 10.9745/ghsp-d-18-00429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/27/2019] [Indexed: 11/15/2022]
Abstract
A comprehensive district-strengthening approach to address maternal and newborn health was estimated to cost US$177 per life-year gained in Uganda and $206 per life-year gained in Zambia. The approach represents a very cost-effective health investment compared to GDP per capita. The primary objective of this study was to estimate the costs and the incremental cost-effectiveness of maternal and newborn care associated with the Saving Mothers, Giving Life (SMGL) initiative—a comprehensive district-strengthening approach addressing the 3 delays associated with maternal mortality—in Uganda and Zambia. To assess effectiveness, we used a before-after design comparing facility outcome data from 2012 (before) and 2016 (after). To estimate costs, we used unit costs collected from comparison districts in 2016 coupled with data on health services utilization from 2012 in SMGL-supported districts to estimate the costs before the start of SMGL. We collected data from health facilities, ministerial health offices, and implementing partners for the year 2016 in 2 SMGL-supported districts in each country and in 3 comparison non-SMGL districts (2 in Zambia, 1 in Uganda). Incremental costs for maternal and newborn health care per SMGL-supported district in 2016 was estimated to be US$845,000 in Uganda and $760,000 in Zambia. The incremental cost per delivery was estimated to be $38 in Uganda and $95 in Zambia. For the districts included in this study, SMGL maternal and newborn health activities were associated with approximately 164 deaths averted in Uganda and 121 deaths averted in Zambia in 2016 compared to 2012. In Uganda, the cost per death averted was $10,311, or $177 per life-year gained. In Zambia, the cost per death averted was $12,514, or $206 per life-year gained. The SMGL approach can be very cost-effective, with the cost per life-year gained as a percentage of the gross domestic product (GDP) being 25.6% and 16.4% in Uganda and Zambia, respectively. In terms of affordability, the SMGL approach could be paid for by increasing health spending from 7.3% to 7.5% of GDP in Uganda and from 5.4% to 5.8% in Zambia.
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Affiliation(s)
- Benjamin Johns
- International Development Division, Abt Associates Inc., Bethesda, MD, USA.
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sophie Faye
- International Development Division, Abt Associates Inc., Bethesda, MD, USA
| | - Mark Tumwine
- Uganda Country Office, U.S. Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Collen Zulu
- U.S. Agency for International Development, Lusaka, Zambia
| | - Marta Levitt
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA, and RTI, Washington, DC, USA. Now with Palladium, Abuja, Nigeria
| | - Tannia Tembo
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jessica Healey
- U.S. Agency for International Development, Lusaka, Zambia. Now based in Monrovia, Liberia
| | - Rui Li
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Azzani M, Dahlui M, Ishak WZW, Roslani AC, Su TT. Provider Costs of Treating Colorectal Cancer in Government Hospital of Malaysia. Malays J Med Sci 2019; 26:73-86. [PMID: 30914895 PMCID: PMC6419868 DOI: 10.21315/mjms2019.26.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/26/2018] [Indexed: 12/27/2022] Open
Abstract
Background The incidence of colorectal cancer (CRC) is rapidly rising in several Asian countries, including Malaysia, but there is little data on health care provider costs in this region. The aim of this study was to estimate the cost of CRC management from the perspective of the health care provider, based on standard operating procedures. Methods A combination of top-down approach and activity-based costing was applied. The standard operating procedure (SOP) for CRC was developed for each stage according to national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost was calculated and incorporated into the treatment pathway in order to obtain the total cost of managing a single CRC patient according to the stage of illness. The cost data were represented by means and standard deviation and the results were demonstrated by tabulation. All cost data are presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late stage (Stage II–IV) was analysed using independent t-test. Results The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30) for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant lower cost compared to late stage t(2) = −4.729, P = 0.042. The highest fraction of the cost was related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II–IV. CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV. The early stages conserved more resources than did the advanced stages of cancer. Conclusion Early diagnosis and management of CRC, therefore, not only affects oncologic prognosis, but has implications for health care costs. This adds further justification to develop and implement CRC screening programmes in Malaysia.
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Affiliation(s)
- Meram Azzani
- Community Medicine Department, Faculty of Medicine, MAHSA University, Saujana Putra Campus, 42610 Jenjarom, Selangor, Malaysia
| | - Maznah Dahlui
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wan Zamaniah Wan Ishak
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - April Camilla Roslani
- University of Malaya Cancer Research Institute (UMCRI), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.,Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Selangor, Malaysia
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Afroz A, Alramadan MJ, Hossain MN, Romero L, Alam K, Magliano DJ, Billah B. Cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries: a systematic review. BMC Health Serv Res 2018; 18:972. [PMID: 30558591 PMCID: PMC6296053 DOI: 10.1186/s12913-018-3772-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes is one of the world’s most prevalent and serious non-communicable diseases (NCDs). It is a leading cause of death, disability and financial loss; moreover, it is identified as a major threat to global development. The chronic nature of diabetes and its related complications make it a costly disease. Estimating the total cost of an illness is a useful aid to national and international health policy decision making. The aim of this systematic review is to summarise the impact of the cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries, and to identify methodological gaps in measuring the cost-of-illness of type 2 diabetes mellitus. Methods This systematic review considers studies that reported the cost-of-illness of type 2 diabetes in subjects aged 18 years and above in low and lower-middle income countries. The search engines MEDLINE, EMBASE, CINAHL, PSYCINFO and COCHRANE were used form date of their inception to September 2018. Two authors independently identified the eligible studies. Costs reported in the included studies were converted to US dollars in relation to the dates mentioned in the studies. Results The systematic search identified eight eligible studies conducted in low and lower-middle income countries. There was a considerable variation in the costs and method used in these studies. The annual average cost (both direct and indirect) per person for treating type 2 diabetes mellitus ranged from USD29.91 to USD237.38, direct costs ranged from USD106.53 to USD293.79, and indirect costs ranged from USD1.92 to USD73.4 per person per year. Hospitalization cost was the major contributor of direct costs followed by drug costs. Conclusion Type 2 diabetes mellitus imposes a considerable economic burden which most directly affects the patients in low and lower-middle income countries. There is enormous scope for adding research-based evidence that is methodologically sound to gain a more accurate estimation of cost and to facilitate comparison between studies. Electronic supplementary material The online version of this article (10.1186/s12913-018-3772-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mohammed J Alramadan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Md Nassif Hossain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred, Melbourne, Australia
| | - Khurshid Alam
- Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Heart Transplantation Cost Composition in Brazil: A Patient-Level Microcosting Analysis and Comparison With International Data. J Card Fail 2018; 24:860-863. [DOI: 10.1016/j.cardfail.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023]
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Salinas-López MA, Soto-Rojas VE, Ocampo CB. [Costs of an Aedes aegypti vector control program in municipalities in Colombia: a case study in Girón and Guadalajara de Buga, 2016]. CAD SAUDE PUBLICA 2018; 34:e00044518. [PMID: 30517314 DOI: 10.1590/0102-311x00044518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to measure the costs of vector-borne disease control programs at the local level in Colombia (2016). A cost analysis was performed for this purpose from the policymaker's perspective in the municipalities (counties) of Girón and Guadalajara de Buga, specifically for the Aedes aegypti control program, the principal mosquito vector of dengue, Zika, and chikungunya. The analysis involved the quantification of all the costs required for each of the prevention and control strategies in vector-borne diseases. The costs were classified as operating and capital costs, and for purposes of comparison the costs were also calculated per case and per capita. The programs' total estimated costs were USD 146,651 in Girón and USD 97,936 in Guadalajara de Buga. Per capita cost was USD 0.88 in Girón and USD 0.99 in Guadalajara de Buga. In general, the predominant cost strategies were chemical spraying of adult mosquitos, accounting for 26% of the total costs in Girón and 47% in Guadalajara de Buga, with personnel representing 40% of the total costs for this strategy in Girón and 66% of the operating costs in Guadalajara de Buga.
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Affiliation(s)
| | - Victoria Eugenia Soto-Rojas
- Universidad Icesi, Cali, Colombia.,Centro de Estudios en Protección Social y Economía de la Salud, Cali, Colombia
| | - Clara Beatriz Ocampo
- Universidad Icesi, Cali, Colombia.,Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia
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Saito MK, Parry CM, Yeung S. Modelling the cost-effectiveness of a rapid diagnostic test (IgMFA) for uncomplicated typhoid fever in Cambodia. PLoS Negl Trop Dis 2018; 12:e0006961. [PMID: 30452445 PMCID: PMC6277117 DOI: 10.1371/journal.pntd.0006961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/03/2018] [Accepted: 10/31/2018] [Indexed: 11/18/2022] Open
Abstract
Typhoid fever is a common cause of fever in Cambodian children but diagnosis and treatment are usually presumptive owing to the lack of quick and accurate tests at an initial consultation. This study aimed to evaluate the cost-effectiveness of using a rapid diagnostic test (RDT) for typhoid fever diagnosis, an immunoglobulin M lateral flow assay (IgMFA), in a remote health centre setting in Cambodia from a healthcare provider perspective. A cost-effectiveness analysis (CEA) with decision analytic modelling was conducted. We constructed a decision tree model comparing the IgMFA versus clinical diagnosis in a hypothetical cohort with 1000 children in each arm. The costs included direct medical costs only. The eligibility was children (≤14 years old) with fever. Time horizon was day seven from the initial consultation. The number of treatment success in typhoid fever cases was the primary health outcome. The number of correctly diagnosed typhoid fever cases (true-positives) was the intermediate health outcome. We obtained the incremental cost effectiveness ratio (ICER), expressed as the difference in costs divided by the difference in the number of treatment success between the two arms. Sensitivity analyses were conducted. The IgMFA detected 5.87 more true-positives than the clinical diagnosis (38.45 versus 32.59) per 1000 children and there were 3.61 more treatment successes (46.78 versus 43.17). The incremental cost of the IgMFA was estimated at $5700; therefore, the ICER to have one additional treatment success was estimated to be $1579. The key drivers for the ICER were the relative sensitivity of IgMFA versus clinical diagnosis, the cost of IgMFA, and the prevalence of typhoid fever or multi-drug resistant strains. The IgMFA was more costly but more effective than the clinical diagnosis in the base-case analysis. An IgMFA could be more cost-effective than the base-case if the sensitivity of IgMFA was higher or cost lower. Decision makers may use a willingness-to-pay threshold that considers the additional cost of hospitalisation for treatment failures.
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Affiliation(s)
- Mari Kajiwara Saito
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Christopher M. Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Shunmay Yeung
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Epiu I, Alia G, Mukisa J, Tavrow P, Lamorde M, Kuznik A. Estimating the cost and cost-effectiveness for obstetric fistula repair in hospitals in Uganda: a low income country. Health Policy Plan 2018; 33:999-1008. [PMID: 30252051 PMCID: PMC6263022 DOI: 10.1093/heapol/czy078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
In Africa, about 33 000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Obstetric fistula repair competes for scarce resources with other healthcare interventions in resource-limited settings, even though it is surgically efficacious. There is limited documentation of its cost-effectiveness in the most affected settings. We therefore sought to assess the cost-effectiveness of surgical intervention for obstetric fistula in Uganda so as to provide appropriate data for policy-makers to prioritize fistula repair and reduce women's suffering in similarly burdened countries. We built a decision-analytic model from the perspective of Uganda's National Health System to estimate the cost-effectiveness of vesico-vaginal and recto-vaginal fistula surgery vs a competing strategy of no surgery for Ugandan women with fistula. Long-term disability outcomes were assessed based on a lifetime Markov state-transition cohort and effectiveness of surgery. Surgical costs were estimated by micro-costing local Ugandan health resources. Disability weights associated with vesico-vaginal, recto-vaginal fistula and mortality rates among the general population in Uganda were based on published sources. The cost of providing fistula repair surgery in Uganda was estimated at $378 per procedure. For a hypothetical 20-year-old woman, surgery was estimated to decrease the lifetime disability burden from 8.53 DALYs to 1.51 DALYs, yielding a cost per DALY averted of $54. The results were robust to variations in model inputs in one-way and probabilistic sensitivity analyses. Surgery for obstetric fistula appears highly cost-effective in Uganda. In similar low-income countries, governments and non-governmental organizations need to prioritize training and strengthening surgical capacity to increase access to fistula surgical care, which would be an important step towards achieving universal health coverage.
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Affiliation(s)
- Isabella Epiu
- NIH Fogarty Global Health Fellow, University of California Global Health Institute, CA, USA and Director Health Solutions International, Kampala, Uganda
| | - Godfrey Alia
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - John Mukisa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Uganda
| | - Paula Tavrow
- Bixby Program in Population and Reproductive Health, University of California at Los Angeles, CA, USA
| | - Mohammed Lamorde
- Prevention Care and Treatment, Infectious Disease Institute, Makerere University College of Health Sciences, Uganda
| | - Andreas Kuznik
- Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Challenges of Costing a Surgical Procedure in a Lower-Middle-Income Country. World J Surg 2018; 43:52-59. [PMID: 30128774 DOI: 10.1007/s00268-018-4773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower-middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHODS A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities. RESULTS The total cost [(interquartile range), number] of TAH was USD 339 [(308-397), n = 24] versus USD 338 [(312-422), n = 25], NDVH was USD 315 [(316-541), n = 23] versus USD 357 [(282-739), n = 26] and TLH was USD 393 [(338-446), n = 24] versus USD 429 [(390-504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy. CONCLUSIONS The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings. TRIAL REGISTRATION The study was registered in the Sri Lanka clinical trials registry (SLCTR/2016/020) and the International Clinical Trials Registry Platform (U1111-1194-8422) on 26 July 2016.
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George G, Chetty T, Strauss M, Inoti S, Kinyanjui S, Mwai E, Romo ML, Oruko F, Odhiambo JO, Nyaga E, Mantell JE, Govender K, Kelvin EA. Costing analysis of an SMS-based intervention to promote HIV self-testing amongst truckers and sex workers in Kenya. PLoS One 2018; 13:e0197305. [PMID: 29979704 PMCID: PMC6034789 DOI: 10.1371/journal.pone.0197305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Objective HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk populations. Methods A costing analysis was conducted for a randomized controlled trial (RCT) with male truckers and female sex workers (FSWs) registered in the electronic health record system (EHRS) of the North Star Alliance, which offers healthcare services at major transit hubs in Southern and East Africa. The RCT selected a sample of truckers and FSWs who were irregular HIV testers, according to the EHRS, and evaluated the effect of SMSs promoting the availability of HIV self-testing (HIVST) kits in Kenyan clinics (intervention program) versus a general SMS reminding clients to test for HIV (enhanced and standard program) on HIV testing rates. In this paper, we calculated costs from a provider perspective using a mixed-methods approach to identify, measure, and value the resources utilized within the intervention and standard programs. The results of the analysis reflect the cost per client tested. Results The cost of offering HIVST was calculated to be double that of routine facility-based testing (USD 10.13 versus USD 5.01 per client tested), primarily due to the high price of the self-test kit. In the two study arms that only offered provider-administered HIV testing in the clinic, only 1% of truckers and 6% of FSWs tested during the study period, while in the intervention arm, which also offered HST, approximately 4% of truckers and 11% of FSWs tested. These lower than expected outcomes resulted in relatively high cost per client estimates for all three study arms. Within the intervention arm, 65% of truckers and 72% of FSWs who tested chose the HIVST option. However, within the intervention arm, the cost per additional client tested was lower for FSWs than for truckers, at USD 0.15 per additional client tested versus USD 0.58 per additional client tested, driven primarily by the higher response rates. Conclusion Whilst the availability of HIVST increased HIV testing among both truckers and FSWs, the cost of providing HIVST is higher than that of a routine health facility-based test, driven primarily by the price of the HIV self-test kit. Future research needs to identify strategies which increase demand for HIVST, and determine whether these strategies and the subsequent increased demand for HIVST are cost-effective in relation to the conventional facility based testing currently available.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Taruna Chetty
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | - Matthew L. Romo
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
- Institute for Implementation Science in Population Health, City University of New York, New York, United States of America
| | | | | | | | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health, New York State Psychiatric Institute & Columbia University, New York, New York, United States of America
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A. Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
- Institute for Implementation Science in Population Health, City University of New York, New York, United States of America
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