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Sharma M, Sra H, Painter C, Pan-ngum W, Luangasanatip N, Chauhan A, Prinja S, Singh M. Cost-effectiveness analysis of surgical masks, N95 masks compared to wearing no mask for the prevention of COVID-19 among health care workers: Evidence from the public health care setting in India. PLoS One 2024; 19:e0299309. [PMID: 38768249 PMCID: PMC11104672 DOI: 10.1371/journal.pone.0299309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/08/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Nonpharmacological interventions, such as personal protective equipment for example, surgical masks and respirators, and maintenance of hand hygiene along with COVID-19 vaccines have been recommended to reduce viral transmission in the community and health care settings. There is evidence from the literature that surgical and N95 masks may reduce the initial degree of exposure to the virus. A limited research that has studied the cost-effective analysis of surgical masks and N95 masks among health care workers in the prevention of COVID-19 in India. The objective of this study was to estimate the cost-effectiveness of N95 and surgical mask compared to wearing no mask in public hospital settings for preventing COVID-19 infection among Health care workers (HCWs) from the health care provider's perspective. METHODS A deterministic baseline model, without any mask use, based on Eikenberry et al was used to form the foundation for parameter estimation and to estimate transmission rates among HCWs. Information on mask efficacy, including the overall filtering efficiency of a mask and clinical efficiency, in terms of either inward efficiency(ei) or outward efficiency(e0), was obtained from published literature. Hospitalized HCWs were assumed to be in one of the disease states i.e., mild, moderate, severe, or critical. A total of 10,000 HCWs was considered as representative of the size of a tertiary care institution HCW population. The utility values for the mild, moderate and severe model health states were sourced from the primary data collection on quality-of-life of HCWs COVID-19 survivors. The utility scores for mild, moderate, and severe COVID-19 conditions were 0.88, 0.738 and 0.58, respectively. The cost of treatment for mild sickness (6,500 INR per day), moderate sickness (10,000 INR per day), severe (require ICU facility without ventilation, 15,000 INR per day), and critical (require ICU facility with ventilation per day, 18,000 INR) per day as per government and private COVID-19 treatment costs and capping were considered. One way sensitivity analyses were performed to identify the model inputs which had the largest impact on model results. RESULTS The use of N95 masks compared to using no mask is cost-saving of $1,454,632 (INR 0.106 billion) per 10,000 HCWs in a year. The use of N95 masks compared to using surgical masks is cost-saving of $63,919 (INR 0.005 billion) per 10,000 HCWs in a year. the use of surgical masks compared to using no mask is cost-saving of $1,390,713 (INR 0.102 billion) per 10,000 HCWs in a year. The uncertainty analysis showed that considering fixed transmission rate (1.7), adoption of mask efficiency as 20%, 50% and 80% reduces the cumulative relative mortality to 41%, 79% and 94% respectively. On considering ei = e0 (99%) for N95 and surgical mask with ei = e0 (90%) the cumulative relative mortality was reduced by 97% and the use of N95 masks compared to using surgical masks is cost-saving of $24,361 (INR 0.002 billion) per 10,000 HCWs in a year. DISCUSSION Both considered interventions were dominant compared to no mask based on the model estimates. N95 masks were also dominant compared to surgical masks.
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Affiliation(s)
- Meenakshi Sharma
- Queens University, Belfast, United Kingdom
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harnoor Sra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chris Painter
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Wirichada Pan-ngum
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Nantasit Luangasanatip
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anil Chauhan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- All India Institute of Medical Sciences, Rishikesh, India
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Gupta N, Gupta D, Vaska KG, Prinja S. Cost-Effectiveness Analysis of Systemic Therapy for Intensification of Treatment in Metastatic Hormone-Sensitive Prostate Cancer in India. Appl Health Econ Health Policy 2024; 22:415-426. [PMID: 38198103 DOI: 10.1007/s40258-023-00866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Androgen-deprivation therapy is the mainstay of treatment for patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). However, the intensification of treatment with either docetaxel or novel anti-androgens (abiraterone-acetate plus prednisone [AAP], enzalutamide, and apalutamide) is being recommended based on the improved clinical outcomes and quality of life among patients. This study aimed to determine the most cost-effective drug for treatment intensification for patients with mHSPC in India. METHODS A Markov model was developed with four health states: progression-free survival, progressive disease, best supportive care, and death. Lifetime costs and consequences were estimated for four treatment sequences: AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost effectiveness using a willingness to pay threshold of 1 × per capita gross domestic product in India. RESULTS We estimated that the total lifetime cost per patient was ₹1,367,454 (US$17,487), ₹2,168,885 (US$27,735), ₹7,678,501 (US$98,190), and ₹1,358,746 (US$17,375) in the AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first treatment sequence, respectively. The mean quality-adjusted life-years lived per patient were 4.78, 5.03, 3.22, and 2.61, respectively. The AAP-first sequence incurs an incremental cost of ₹4014 (US$51) per quality-adjusted life-year gained as compared with the docetaxel-first sequence, with a 87% probability of being cost effective at the willingness-to-pay threshold of 1 × per-capita gross domestic product of India. The use of AAP-first also incurs an incremental net monetary benefit of ₹396,491 (US$5070) as compared with the docetaxel-first treatment sequence. Nearly a 48% reduction in the price of enzalutamide is required to make it a cost-effective treatment sequence as compared with AAP-first in India. CONCLUSIONS We concur with the inclusion of standard-dose AAP in India's publicly financed health insurance scheme for the intensification of treatment in mHSPC as it is the only cost-effective sequence among the various novel anti-androgens when compared with the docetaxel-first treatment sequence. Furthermore, a systematic reduction in the price of enzalutamide would further help to improve clinical outcomes among patients with mHSPC.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Madhya Marg, Near Gol Market, Sector 14, Chandigarh, 160014, India
| | - Kiran Gopal Vaska
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Madhya Marg, Near Gol Market, Sector 14, Chandigarh, 160014, India.
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Sharma A, Prinja S, Thakur R, Gupta D, Kaur R, Sharma S, Munjal S, Panda N. Healthcare Cost of Cochlear Implantation in India. Indian J Otolaryngol Head Neck Surg 2024; 76:1716-1723. [PMID: 38566707 PMCID: PMC10982277 DOI: 10.1007/s12070-023-04389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04389-7.
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Affiliation(s)
- Anuradha Sharma
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Thakur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dharna Gupta
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajwinder Kaur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sameer Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Munjal
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh Panda
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Dixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, Singh A, Malhotra P, Gupta D, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S, Prinja S. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes 2024; 22:26. [PMID: 38481231 PMCID: PMC10938809 DOI: 10.1186/s12955-024-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. METHODS Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. RESULTS Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45-60 years and females (49.3-58.3%). Most patients were found to be in stage III (40-40.6%) or stage IV (29.4-37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). CONCLUSION Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Amal Kataki
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Partha Roy
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Dixit J, Malhotra P, Mehra N, Mathew A, Kumar L, Singh A, Gupta N, Krishnamurthy MN, Roy PS, Kataki AC, Gupta S, Prinja S. Cost-Effectiveness of Novel Agent Regimens for Transplant-Eligible Newly Diagnosed Multiple Myeloma Patients in India. Appl Health Econ Health Policy 2024:10.1007/s40258-024-00877-1. [PMID: 38448720 DOI: 10.1007/s40258-024-00877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Survival outcomes for multiple myeloma have improved dramatically since the introduction of novel therapeutic agents. While these drugs are highly effective in improving survival outcomes and quality of life in patients with multiple myeloma, they come at a significant cost. We assessed the cost-effectiveness of bortezomib-based triplet or quadruplet drug regimens in isolation and followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of newly diagnosed multiple myeloma (NDMM) in the Indian context. METHODS A Markov model was developed to assess the health and economic outcomes of novel drug regimens with and without AHSCT for the treatment of NDMM in India. We estimated the lifetime quality-adjusted life-years (QALYs) and costs in each scenario. The incremental cost-effectiveness ratios (ICERs) were computed and compared against the current willingness-to-pay threshold of a one-time per capita gross domestic product of ₹146,890 (US$1,927.70) for India. Parameter uncertainty was assessed through Monte Carlo probabilistic sensitivity analysis. RESULTS Among seven treatment sequences, the VCd (bortezomib, cyclophosphamide, dexamethasone) alone arm has the lowest cost and health benefits as compared to four treatment sequences, namely VTd (bortezomib, thalidomide, dexamethasone) alone, VRd (bortezomib, lenalidomide, dexamethasone) alone, VRd plus AHSCT and DVRd (Daratumumab, bortezomib, lenalidomide, dexamethasone) plus AHSCT. It was found that VTd plus AHSCT and VCd plus AHSCT arms were extendedly dominated (ED) by combination of two alternative treatments. Among the five non-dominated strategies, VRd has a lowest incremental cost of ₹ 2,20,093 (US$2,888) per QALY gained compared to VTd alone followed by VRd plus AHSCT [₹3,14,530 (US$4,128) per QALY gained] in comparison to VRd alone. None of the novel treatment sequences were found to be cost-effective at the current WTP threshold of ₹1,46,890 (US$1,927.7). CONCLUSION At the current WTP threshold of one-time per capita GDP (₹ 146,890) of India, VRd alone and VRd plus AHSCT has 38.1% and 6.9% probability to be cost-effective, respectively. Reduction in current reimbursement rates of novel drugs, namely VRd, lenalidomide, and pomalidomide plus dexamethasone under national insurance program and societal cost of transplant by 50%, would make VRd plus AHSCT and VTd plus AHSCT cost-effective at an incremental cost of ₹40,671 (US$34) and ₹97,639 (US$1,281) per QALY gained, respectively.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Amal Chandra Kataki
- Department of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Wadhwa R, Gupta N, Dixit J, Malhotra P, Lakshmi PVM, Prinja S. Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India. JCO Glob Oncol 2024; 10:e2300396. [PMID: 38452304 PMCID: PMC10939583 DOI: 10.1200/go.23.00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/25/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Denosumab is clinically superior to zoledronic acid (ZA) for preventing and delaying time to first and subsequent skeletal-related events (SREs) among patients with breast cancer (BC) with bone metastases. We evaluated the cost and health benefits of denosumab and ZA (once every 4 weeks and once every 12 weeks) among four different molecular subtypes of BC with bone metastases in India. MATERIALS AND METHODS A Markov model was developed in Microsoft Excel to estimate lifetime health consequences and resulting costs among cohort of 1,000 patients with BC with bone metastasis, for three intervention scenarios, namely denosumab (once every 4 weeks), ZA (once every 4 weeks), and ZA (once every 12 weeks). The health outcomes were measured in terms of SREs averted and quality-adjusted life-years (QALYs) gained. The cost of each intervention scenario was measured using both the health system and the patient's perspectives. Indirect costs because of lost productivity were not included. The future costs and outcomes were discounted at the standard rate of 3%. RESULTS Over a lifetime, the incremental number of SREs averted with use of denosumab once every 4 weeks (compared with ZA once every 4 weeks and once every 12 weeks) among patients with luminal A, luminal B, human epidermal growth factor receptor 2-enriched, and triple negative breast cancer were estimated as 0.39, 0.26, 0.25, and 0.19, respectively. The number of QALYs lived were slightly higher in the denosumab arm (1.45-2.80) compared with ZA once every 4 weeks and once every 12 weeks arms (1.44-2.78). However, denosumab once every 4 weeks was not found to be a cost-effective alternative for either of the four molecular subtypes of breast cancer. ZA once every 12 weeks was found to be a cost-effective option with an average cost-effectiveness ratio ranging between ₹68,254 and ₹73,636. CONCLUSION ZA once every 12 weeks is the cost-effective treatment option for BC with bone metastases in India. The present study findings hold significance for standard treatment guidelines under India's government-funded health insurance program.
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Affiliation(s)
- Raina Wadhwa
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - PVM Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Gupta D, Gupta N, Singh N, Prinja S. Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase- and ROS1 Fusion-Positive Non-Small Cell Lung Cancer in India. JCO Glob Oncol 2024; 10:e2300260. [PMID: 38359374 PMCID: PMC10881089 DOI: 10.1200/go.23.00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Targeted therapies, such as crizotinib and ceritinib, have shown promising results in treating non-small cell lung cancer (NSCLC) with specific oncogenic drivers like anaplastic lymphoma kinase (ALK), c-ros (ROS1) oncogene, etc. This study aims to assess the cost-effectiveness of these therapies for patients with NSCLC in India. METHODS The Markov model consisted of three health states: progression-free survival, progressive disease, and death. Lifetime costs and consequences were estimated for three treatment arms: crizotinib, ceritinib, and chemotherapy for patients with ALK- and ROS1-positive NSCLC. Incremental cost per quality-adjusted life-year (QALY) gained with crizotinib and ceritinib was compared to chemotherapy and assessed using a willingness-to-pay threshold of one-time per capita gross domestic product in India. RESULTS The total lifetime cost per patient for ALK-positive NSCLC was ₹332,456 ($4,054 US dollars [USD]), ₹1,284,100 ($15,659 USD), and ₹2,337,779 ($28,509 USD) in the chemotherapy, crizotinib, and ceritinib arms, respectively. The mean QALYs lived per patient were 1.20, 2.21, and 3.34, respectively. For patients with ROS1-positive NSCLC, the total cost was ₹323,011 ($3,939 USD) and ₹1,763,541 ($21,507 USD) for chemotherapy and crizotinib, with mean QALYs lived per patient of 1.16 and 2.73, respectively. Nearly 92% and 81% reduction in the price of ceritinib and crizotinib is required to make it a cost-effective treatment option for ALK- and ROS1-positive NSCLC, respectively. CONCLUSION Our study findings suggest that the prices of ceritinib and crizotinib need to be reduced significantly to justify their value for inclusion in India's publicly financed health insurance scheme for treatment of patients with locally advanced/metastatic ALK- and ROS1-positive NSCLC, respectively.
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Affiliation(s)
- Dharna Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Gheorghe A, Mehndiratta A, Baker P, Culyer A, Prinja S, Kar SS, Guzman J. Health technology assessment in India in the next decade: reflections on a vision for its path to maturity and impact. BMJ Evid Based Med 2024:bmjebm-2023-112491. [PMID: 38290800 DOI: 10.1136/bmjebm-2023-112491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Adrian Gheorghe
- Center for Global Development, Washington, District of Columbia, USA
- Imperial College London, London, UK
| | - Abha Mehndiratta
- Center for Global Development, Washington, District of Columbia, USA
| | - Peter Baker
- Center for Global Development, Washington, District of Columbia, USA
| | | | | | | | - Javier Guzman
- Center for Global Development, Washington, District of Columbia, USA
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Jyani G, Prinja S, Goyal A, Garg B, Kaur M, Grover S. Do people with different sociodemographic backgrounds value their health differently? Evaluating the role of positional objectivity. Front Public Health 2023; 11:1234320. [PMID: 38162609 PMCID: PMC10756676 DOI: 10.3389/fpubh.2023.1234320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective The fundamental disconnect between the actual and the perceived health of an individual raises considerable skepticism on the self-reported health data as it may be confounded by an individual's socio-economic status. In this light, the present study aims to assess if people with different sociodemographic backgrounds value their health differently. Methods The health-state valuation using time-trade off was performed in a cross-sectional survey among a representative sample of 2,311 adults from India. Individuals were selected using a multistage stratified random sampling from five Indian states to elicit their present health-state, and to perform the health-state valuation exercise using computer assisted personal interviewing. A single block of standardized health-states was valued by multiple individuals, each belonging to different socio-demographic group. The difference in the valuation of health was assessed using bivariate analysis. The impact of different sociodemographic factors on the health-state valuation was evaluated using Tobit regression model. Results Differences in the valuation of health were observed among different groups of age, religion, family type, state of residence, substance abuse, presence of ailments at the time of valuation, and number of dependent members in the household. Even after controlling for the severity of the administered health states, factors having a significant association with the valuation of health are age, religion, state of residence, substance abuse, family type, number of dependent members in the household, and presence of chronic or both acute and chronic ailments. Younger individuals place a higher value to their health as compared to their older counterparts. As compared to a healthy individual, a person with ailments rates the same health-state as worse. Conclusion Inequalities in self-reported ill-health cannot be attributed to positional objectivity; age, religion, state of residence, substance abuse, family type, dependents, and ailments impact individual health valuation.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Basant Garg
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Prinja S, Chugh Y, Garg B, Guinness L. National hospital costing systems matter for universal healthcare: the India PM-JAY experience. BMJ Glob Health 2023; 8:e012987. [PMID: 37963613 PMCID: PMC10649618 DOI: 10.1136/bmjgh-2023-012987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
India envisions achieving universal health coverage to provide its people with access to affordable quality health services. A breakthrough effort in this direction has been the launch of the world's largest health assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the implementation of which resides with the National Health Authority. Appropriate provider payment systems and reimbursement rates are an important element for the success of PM-JAY, which in turn relies on robust cost evidence to support pricing decisions. Since the launch of PM-JAY, the health benefits package and provider payment rates have undergone a series of revisions. At the outset, there was a relative lack of cost data. Later revisions relied on health facility costing studies, and now there is an initiative to establish a national hospital costing system relying on provider-generated data. Lessons from PM-JAY experience show that the success of such cost systems to ensure regular and routine generation of evidence is contingent on integrating with existing billing or patient information systems or management information systems, which digitise similar information on resource consumption without any additional data entry effort. Therefore, there is a need to focus on building sustainable mechanisms for setting up systems for generating accurate cost data rather than relying on resource-intensive studies for cost data collection.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashika Chugh
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Basant Garg
- National Health Authority, Government of India, New Delhi, India
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, UK
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Hegde NC, Kumar A, Kaundal S, Saha L, Malhotra P, Prinja S, Lad D, Patil AN. Generic ibrutinib a potential cost-effective strategy for the first-line treatment of chronic lymphocytic leukaemia. Ann Hematol 2023; 102:3125-3132. [PMID: 37439892 DOI: 10.1007/s00277-023-05342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Abstract
Though the chronic lymphocytic leukaemia (CLL) management options in India are still limited compared to the novel drug options in resource-rich settings, the availability of less costly generics and the government health insurance scheme has enabled many patients to access the newer drugs in India. The current study compared the cost-effectiveness and cost-utility of existing initial management options for the progression-free survival (PFS) time horizon from the patient's perspective. A two-health-state, PFS and progressive disease, Markov model was assumed for three regimens (generics): ibrutinib monotherapy, bendamustine-rituximab (B-R), and rituximab-chlorambucil (RClb) used as the frontline treatment of CLL patients in India. All costs, utilization of services, and consequences data during the PFS period were collected from interviewing patients during follow-up visits. The transition probability (TP) and average PFS information were obtained from landmark published studies. EQ-5D-5L questionnaires were utilized to assess the quality of life (QoL). Quality-adjusted life years (QALY) were measured during the PFS period. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were studied. Upon analysis, the entire monetary expense during the PFS time was ₹1581964 with ibrutinib, ₹171434 with B-R, and ₹91997 with RClb treatment arm. Pooled PFS and QALY gain was 10.33 and 8.28 years for ibrutinib, 4.08 and 3.53 years for the B-R regimen, and 1.33 and 1.23 years in RClb arms, respectively. Ibrutinib's ICER and ICUR were ₹214587.32 per PFS year gain and ₹282384.86 per QALY gain when assessed against the B-R regimen. Ibrutinib also performed better in ICER and ICUR against the RClb arm with ₹157014.29 per PFS year gain and ₹200413.6 per QALY gain. In conclusion, generic ibrutinib is a cost-effective initial line of management compared to other commonly used treatment regimes in resource-limited settings.
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Affiliation(s)
| | - Ankit Kumar
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Shaweta Kaundal
- Department of Clinical Hematology & Medical Oncology, PGIMER, Chandigarh, India
| | - Lekha Saha
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, PGIMER, Chandigarh, India
| | | | - Deepesh Lad
- Department of Clinical Hematology & Medical Oncology, PGIMER, Chandigarh, India.
| | - Amol N Patil
- Department of Pharmacology, PGIMER, Chandigarh, India.
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Prinja S, Bahuguna P, Singh MP, Guinness L, Goyal A, Aggarwal V. Refining the provider payment system of India's government-funded health insurance programme: an econometric analysis. BMJ Open 2023; 13:e076155. [PMID: 37857541 PMCID: PMC10603525 DOI: 10.1136/bmjopen-2023-076155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES Reimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under India's publicly financed national health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), by exploring and quantifying the influence of supply-side factors on the costs of inpatient admissions and surgical procedures. DESIGN Exploratory analysis using regression-based cost function on data from a multisite health facility costing study-the Cost of Health Services in India (CHSI) Study. SETTING The CHSI Study sample included 11 public sector tertiary care hospitals, 27 public sector district hospitals providing secondary care and 16 private hospitals, from 11 Indian states. PARTICIPANTS 521 sites from 57 healthcare facilities in 11 states of India. INTERVENTIONS Medical and surgical packages of PM-JAY. PRIMARY AND SECONDARY OUTCOME MEASURES The cost per bed-day and cost per surgical procedure were regressed against a range of factors to be considered as weights including hospital location, presence of a teaching function and ownership. In addition, capacity utilisation, number of beds, specialist mix, state gross domestic product, State Health Index ranking and volume of patients across the sample were included as variables in the models. Given the skewed data, cost variables were log-transformed for some models. RESULTS The estimated mean costs per inpatient bed-day and per procedure were 2307 and 10 686 Indian rupees, respectively. Teaching status, annual hospitalisation, bed size, location of hospital and average length of hospitalisation significantly determine the inpatient bed-day cost, while location of hospital and teaching status determine the procedure costs. Cost per bed-day of teaching hospitals was 38-143.4% higher than in non-teaching hospitals. Similarly, cost per bed-day was 1.3-89.7% higher in tier 1 cities, and 19.5-77.3% higher in tier 2 cities relative to tier 3 cities, respectively. Finally, cost per surgical procedure was higher by 10.6-144.6% in teaching hospitals than non-teaching hospitals; 12.9-171.7% higher in tier 1 cities; and 33.4-140.9% higher in tier 2 cities compared with tier 3 cities, respectively. CONCLUSION Our study findings support and validate the recently introduced differential provider payment system under the PM-JAY. While our results are indicative of heterogeneity in hospital costs, other considerations of how these weights will affect coverage, quality, cost containment, as well as create incentives and disincentives for provider and consumer behaviour, and integrate with existing price mark-ups for other factors, should be considered to determine the future revisions in the differential pricing scheme.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vipul Aggarwal
- Government of India, National Health Authority, New Delhi, India
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Sharma M, Dhillon MS, Singh A, Prinja S, Bahuguna P, Singh M, Adhya B, Negi S, Verma N. Protocol for a quasi-experimental study to ascertain the effectiveness of using eKnee School approach to impart self-care education to patients suffering from knee osteoarthritis during COVID-19 pandemic. J Educ Health Promot 2023; 12:301. [PMID: 38023075 PMCID: PMC10671000 DOI: 10.4103/jehp.jehp_1758_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) patients seek improvement in their quality of life by attaining independence in activities of daily living. Literature recommends nonpharmacological intervention as first-line treatment for KOA. The study aims to ascertain the effectiveness of online supervised nonpharmacological intervention sessions of virtual knee school (eKS) training among mild and moderate KOA patients in comparison to routine care during COVID-19 pandemic and assessment of cost-effectiveness of eKS against the routine care for KOA patients during COVID-19 pandemic. MATERIALS AND METHODS A quasi-experimental pre-post with control group, enrolling 50 participants each in two groups: usual/routine KOA care or usual care plus KS interventions via virtual mode. Our primary outcome measures are pain, quality of life, and incremental cost-effectiveness ratio. Secondary outcomes include performance-based tests (30-second chair test, timed up and go test, 6-minute walk test) and patient satisfaction. Intervention fidelity will be assessed with a priori checklist tailored to eKS assessing adherence, dose, quality, and user engagement in the key components. Quantitative data collection will be conducted at baseline and 6 months. Descriptive data analysis will be carried for quantitative data. For qualitative data, the thematic analysis will be performed; we propose to undertake a deterministic and probabilistic sensitivity analysis to address the issue of uncertainty in the present cost-effectiveness analysis model. CONCLUSION The management of KOA through virtual mode emphasizes the concepts of patient-as-person, family-centered, with socially interactive approach. The study will provide information on the effectiveness of nonpharmacological interventions for improving the quality of life of patients suffering from KOA through virtual knee school. Nevertheless, pitfalls in running eKS will be noted, which will help improve all aspects of online medical communications in the future.
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Affiliation(s)
- Meenakshi Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep S. Dhillon
- Department of Orthopaedics and Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics, and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Meenu Singh
- Department of Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bibek Adhya
- Department of Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Negi
- Department of Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishank Verma
- Department of Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sharma D, Prinja S, Aggarwal AK, Rajsekar K, Bahuguna P. Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment. Lancet Reg Health Southeast Asia 2023; 16:100241. [PMID: 37694178 PMCID: PMC10485782 DOI: 10.1016/j.lansea.2023.100241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 09/12/2023]
Abstract
Background Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.
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Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K. Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Chauhan AS, Sharma D, Mehndiratta A, Gupta N, Garg B, Kumar AP, Prinja S. Validating the rigour of adaptive methods of economic evaluation. BMJ Glob Health 2023; 8:e012277. [PMID: 37751935 PMCID: PMC10533726 DOI: 10.1136/bmjgh-2023-012277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND There has been a lot of debate on how to 'generalise' or 'translate' findings of economic evaluation (EE) or health technology assessment (HTA) to other country contexts. Researchers have used various adaptive HTA (aHTA) methods like model-adaptation, price-benchmarking, scorecard-approach, etc., for transferring evidence from one country to other. This study was undertaken to assess the degree of accuracy in results generated from aHTA approaches specifically for EE. METHODS By applying selected aHTA approaches, we adapted findings of globally published EE to Indian context. The first-step required identifying two interventions for which Indian EE (referred to as the 'Indian reference study') has been conducted. The next-step involved identification of globally published EE. The third-step required undertaking quality and transferability check. In the fourth step, outcomes of EE meeting transferability standards, were adapted using selected aHTA approaches. Lastly, adapted results were compared with findings of the Indian reference study. RESULTS The adapted cost estimates varied considerably, while adapted quality-adjusted life-years did not differ much, when matched with the Indian reference study. For intervention I (trastuzumab), adapted absolute costs were 11 and 6 times higher than the costs reported in the Indian reference study for control and intervention arms, respectively. Likewise, adapted incremental cost and incremental cost-effectiveness ratio (ICER) were around 3.5-8 times higher than the values reported in the Indian reference study. For intervention II (intensity-modulated radiation therapy), adapted absolute cost was 35% and 12% lower for the comparator and intervention arms, respectively, than the values reported in the Indian reference study. The mean incremental cost and ICER were 2.5 times and 1.5 times higher, respectively, than the Indian reference study values. CONCLUSION We conclude that findings from aHTA methods should be interpreted with caution. There is a need to develop more robust aHTA approaches for cost adjustment. aHTA may be used for 'topic prioritisation' within the overall HTA process, whereby interventions which are highly cost-ineffective, can be directly ruled out, thus saving time and resources for conducting full HTA for interventions that are not well studied or where evidence is inconclusive.
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Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Basant Garg
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Amneet P Kumar
- Department of Women and Child Development, Government of Haryana, Panchkula, Haryana, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jyani G, Yang Z, Sharma A, Goyal A, Stolk E, Purba FD, Grover S, Kaur M, Prinja S. Evaluation of EuroQol Valuation Technology (EQ-VT) Designs to Generate National Value Sets: Learnings from the Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study. Med Decis Making 2023; 43:692-703. [PMID: 37480281 PMCID: PMC10422850 DOI: 10.1177/0272989x231180134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/27/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Countries develop their EQ-5D-5L value sets using the EuroQol Valuation Technology (EQ-VT) protocol. This study aims to assess if extension in the conventional EQ-VT design can lead to development of value sets with improved precision. METHODS A cross-sectional survey was undertaken in a representative sample of 3,548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. A novel extended EQ-VT design was created that included 18 blocks of 10 health states, comprising 150 unique health states and 135 observations per health state. In addition to the standard EQ-VT design, which is based on 86 health states and 100 observations per health state, 3 extended designs were assessed for their predictive performance. The extended designs were created by 1) increasing the number of observations per health state in the design, 2) increasing the number of health states in the design, and 3) implementing both 1) and 2) at the same time. Subsamples of the data set were created for separate designs. The root mean squared error (RMSE) and mean absolute error (MAE) were used to measure the predictive accuracy of the conventional and extended designs. RESULTS The average RMSE and MAE for the standard EQ-VT design were 0.055 and 0.041, respectively, for the 150 health states. All 3 types of design extensions showed lower RMSE and MAE values as compared with the standard design and hence yielded better predictive performance. RMSE and MAE were lowest (0.051 and 0.039, respectively) for the designs that use a greater number of health states. Extending the design with inclusion of more health states was shown to improve the predictive performance even when the sample size was fixed at 1,000. CONCLUSION Although the standard EQ-VT design performs well, its prediction accuracy can be further improved by extending its design. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. HIGHLIGHTS The EQ-5D-5L value sets are developed using the standardized EuroQol Valuation Technology (EQ-VT) protocol. This is the first study to empirically assess how much can be gained from extending the standard EQ-VT design in terms of sample size and/or health states. It not only presents useful insights into the performance of the standard design of the EQ-VT but also tests the potential extensions in the standard EQ-VT design in terms of increasing the health states to be directly valued as well as the number of observations recorded to predict the utility value of each of these health states.The study demonstrates that the standard EQ-VT design performs good, and an extension in the design of the standard EQ-VT can lead to further improvement in its performance. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. Extending the design with inclusion of more health states marginally improves the predictive performance even when the sample size was fixed at 1,000.The findings of the study will streamline the systematic process for generating precise EQ-5D-5L value sets, thus facilitating the conduct of credible, transparent, and robust outcome valuation in health technology assessments.
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Affiliation(s)
- Gaurav Jyani
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Zhihao Yang
- Guizhou Medical University, Guiyang, People’s Republic of China
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aarti Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, South Holland, the Netherlands
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
| | - Sandeep Grover
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Prinja S, Singh MP, Bahuguna P. India's publicly financed insurance scheme: scope for revision - authors' reply. Lancet Reg Health Southeast Asia 2023; 14:100236. [PMID: 37492422 PMCID: PMC10363489 DOI: 10.1016/j.lansea.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- National Health Authority, Government of India, New Delhi, India
| | - Maninder Pal Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Prinja S, Dixit J, Gupta N, Dhankhar A, Kataki AC, Roy PS, Mehra N, Kumar L, Singh A, Malhotra P, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S. Financial toxicity of cancer treatment in India: towards closing the cancer care gap. Front Public Health 2023; 11:1065737. [PMID: 37404274 PMCID: PMC10316647 DOI: 10.3389/fpubh.2023.1065737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/18/2023] [Indexed: 07/06/2023] Open
Abstract
Background The rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities. Methods A total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression. Results Mean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment. Conclusion There is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Anushikha Dhankhar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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Lahariya C, Sahoo KC, Sundararaman T, Prinja S, Rajsekhar K, Pati S. Universal health coverage in India and health technology assessment: current status and the way forward. Front Public Health 2023; 11:1187567. [PMID: 37333525 PMCID: PMC10272558 DOI: 10.3389/fpubh.2023.1187567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
In India, there is a renewed emphasis on Universal Health Coverage (UHC). Alongside this, Health Technology Assessment (HTA) is an important tool for advancing UHC. The development and application of HTA in India, including capacity building and establishing institutional mechanisms. We emphasized using the HTA approach within two components of the Ayushman Bharat programme, and the section concludes with lessons learned and the next steps. The UHC has increased the importance of selecting and implementing effective technologies and interventions within national health systems, particularly in the context of limited resources. To maximize the use of limited resources and produce reliable scientific assessments, developing and enhancing national capacity must be based on established best practices, information exchange between different sectors, and collaborative approaches. A more potent mechanism and capacity for HTA in India would accelerate the country's progress toward UHC.
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Affiliation(s)
- Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, India
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - T. Sundararaman
- Former Dean, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Sanghamitra Pati
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Nehra P, Chauhan AS, Malhotra P, Kumar L, Singh A, Gupta N, Mehra N, Mathew A, Kataki AC, Gupta S, Prinja S. Cost-effectiveness analysis of different combination therapies for the treatment of chronic lymphocytic leukaemia in India. Lancet Reg Health Southeast Asia 2023; 13:100201. [PMID: 37383548 PMCID: PMC10305972 DOI: 10.1016/j.lansea.2023.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/24/2022] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
Background Over the years, there has been introduction of newer drugs, like bendamustine and ibrutinib, for the management of chronic lymphocytic leukaemia (CLL). Though these drugs lead to better survival, they are also associated with higher cost. The existing evidence on cost effectiveness of these drugs is from high-income countries, which has limited generalisability for low-income and middle-income counties. Therefore, the present study was undertaken to assess the cost-effectiveness of three therapeutic regimens, chlorambucil plus prednisolone (CP), bendamustine plus rituximab (BR) and ibrutinib for CLL treatment in India. Methods A Markov model was developed for estimating lifetime costs and consequences in a hypothetical cohort of 1000 CLL patients following treatment with different therapeutic regimens. The analysis was performed based on a limited societal perspective, 3% discount rate and lifetime horizon. The clinical effectiveness of each regime in the form of progression-free survival and occurrence of adverse events were assessed from various randomised controlled trials. A structured comprehensive review of literature was undertaken for the identification of relevant trials. The data on utility values and out of pocket expenditure was obtained from primary data collected from 242 CLL patients across six large cancer hospitals in India. Findings As compared to the most affordable regimen comprising of CP as first-line followed by BR as second-line therapy, none of the other therapeutic regimens were cost-effective at one time per capita gross-domestic product of India. However, if the current price of either combination of BR and ibrutinib or even ibrutinib alone could be reduced by more than 80%, regimen comprising of BR as first-line therapy followed by second-line ibrutinib would become cost-effective. Interpretation At the current market prices, regimen comprising of CP as first-line followed by BR as second-line therapy is the most cost-effective strategy for CLL treatment in India. Funding Department of Health Research, Government of India.
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Affiliation(s)
- Prerika Nehra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amal Chandra Kataki
- Department of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Brar S, Kaur G, Muniyandi M, Karikalan N, Bano H, Bhansali A, Jain S, Kumari S, Prinja S. Cost of screening, out-of-pocket expenditure & quality of life for diabetes & hypertension in India. Indian J Med Res 2023; 157:498-508. [PMID: 37530305 PMCID: PMC10466497 DOI: 10.4103/ijmr.ijmr_389_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Indexed: 08/03/2023] Open
Abstract
Background & objectives The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ₹ 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ₹ 4381 (95% confidence interval [CI]: 3786-4976), ₹ 1427 (95% CI: 1278-1576) and ₹ 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.
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Affiliation(s)
- Sehr Brar
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Gunjeet Kaur
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Malaisamy Muniyandi
- Department of Health Economics, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Nagarajan Karikalan
- Department of Health Economics, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Henna Bano
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Savita Kumari
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Chandigarh, India
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Faujdar DS, Prinja S, Singh T, Sahay S, Kumar R. Costing analysis of an information & communications technology-enabled primary healthcare facility in India. Indian J Med Res 2023; 157:231-238. [PMID: 37282386 PMCID: PMC10438417 DOI: 10.4103/ijmr.ijmr_454_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND & OBJECTIVES Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. METHODS We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. RESULTS The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. INTERPRETATION & CONCLUSIONS Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.
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Affiliation(s)
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Chandigarh, India
- Former Dean (Academic), Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Kumar D, Prinja S. Costing of services under National Tuberculosis Elimination Program at public health facilities of northern India. Indian J Tuberc 2023; 70:232-238. [PMID: 37100581 DOI: 10.1016/j.ijtb.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND Costing of resources helps to measure financial implications and effective utilization of resources of national programs. As there is limited evidence about cost per service, current study was done to assess the cost of services under National Tuberculosis Elimination Program (NTEP) at Community Health Centres (CHCs) and Primary Health Centres (PHCs) of northern state of India. MATERIAL AND METHODS Cross-sectional study carried out in two districts and from each district eight CHCs and PHCs were randomly selected. RESULTS Mean annual cost of providing NTEP services at CHCs and PHCs were US$5243.1 (95%CI: 3008.0-7225.4) and US$1031.9 (95%CI: 669.1-1447.1) respectively. Across both centres human resource contributes to the most (CHC: 72.9%; PHC: 85.9%). One way sensitivity analysis was carried out for all health facilities and observed that human resource cost influences most cost per treated case by providing services under NTEP. Although relatively very less but cost of drugs also influences cost per treatment. CONCLUSION Cost of delivering services was high for CHCs as compared to PHCs. At both types of health facilities, human resource contributes the most to cost of delivering services under the program.
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Affiliation(s)
- Dinesh Kumar
- Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, 176001, India.
| | - Shankar Prinja
- School of Public Health and Community Medicine, Post Graduate Institute of Medical Education and Research. Chandigarh, 160012, India.
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Rana K, Goel S, Prinja S. Effect of tobacco taxation on smoking prevalence and smoking-attributable deaths in India. Indian J Public Health 2023; 67:278-283. [PMID: 37459025 DOI: 10.4103/ijph.ijph_93_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. Objectives The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking-attributable deaths in India. Materials and Methods A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking-attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. Results A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking-attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco-related diseases by 2025. Conclusion The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking-attributable mortality.
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Affiliation(s)
- Kirtan Rana
- Assistant Professor, Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sonu Goel
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sinha A, Bahuguna P, Gupta SS, Kuruba YP, Poluru R, Mathur A, Raja D, Raut AV, Mahajan KS, Sudhakar R, Kulkarni B, Pandey RM, Arora NK, Prinja S. Study protocol for economic evaluation of probiotic intervention for prevention of neonatal sepsis in 0-2-month old low-birth weight infants in India: the ProSPoNS trial. BMJ Open 2023; 13:e068215. [PMID: 36990484 PMCID: PMC10069556 DOI: 10.1136/bmjopen-2022-068215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION The ProSPoNS trial is a multicentre, double-blind, placebo-controlled trial to evaluate the role of probiotics in prevention of neonatal sepsis. The present protocol describes the data and methodology for the cost utility of the probiotic intervention alongside the controlled trial. METHODS AND ANALYSIS A societal perspective will be adopted in the economic evaluation. Direct medical and non-medical costs associated with neonatal sepsis and its treatment would be ascertained in both the intervention and the control arm. Intervention costs will be facilitated through primary data collection and programme budgetary records. Treatment cost for neonatal sepsis and associated conditions will be accessed from Indian national costing database estimating healthcare system costs. A cost-utility design will be employed with outcome as incremental cost per disability-adjusted life year averted. Considering a time-horizon of 6 months, trial estimates will be extrapolated to model the cost and consequences among high-risk neonatal population in India. A discount rate of 3% will be used. Impact of uncertainties present in analysis will be addressed through both deterministic and probabilistic sensitivity analysis. ETHICS AND DISSEMINATION Has been obtained from EC of the six participating sites (MGIMS Wardha, KEM Pune, JIPMER Puducherry, AIPH, Bhubaneswar, LHMC New Delhi, SMC Meerut) as well as from the ERC of LSTM, UK. A peer-reviewed article will be published after completion of the study. Findings will be disseminated to the community of the study sites, with academic bodies and policymakers. REGISTRATION The protocol has been approved by the regulatory authority (Central Drugs Standards Control Organisation; CDSCO) in India (CT-NOC No. CT/NOC/17/2019 dated 1 March 2019). The ProSPoNS trial is registered at the Clinical Trial Registry of India (CTRI). Registered on 16 May 2019. TRIAL REGISTRATION NUMBER CTRI/2019/05/019197; Clinical Trial Registry.
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Affiliation(s)
- Anju Sinha
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland's Western Lowlands, UK
| | | | - Yamini Priyanka Kuruba
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ramesh Poluru
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Apoorva Mathur
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Dilip Raja
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Abhishek V Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Kamaleshwar S Mahajan
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | | | - Bharati Kulkarni
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra K Arora
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
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Kc S, Lin LW, Bayani DBS, Zemlyanska Y, Adler A, Ahn J, Chan K, Choiphel D, Genuino-Marfori AJ, Kearney B, Liu Y, Nakamura R, Pearce F, Prinja S, Pwu RF, Akmal Shafie A, Sui B, Suwantika A, Tunis S, Wu HM, Zalcberg J, Zhao K, Isaranuwatchai W, Teerawattananon Y, Wee HL. What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection Into the Past and A Way Forward. Int J Health Policy Manag 2023; 12:6858. [PMID: 37579427 PMCID: PMC10461954 DOI: 10.34172/ijhpm.2023.6858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators. METHODS The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE. RESULTS All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA, and (b) the relative importance and prioritization of RWE being used for policy-making. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled. CONCLUSION The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.
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Affiliation(s)
- Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Lydia Wenxin Lin
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | | | - Yaroslava Zemlyanska
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Amanda Adler
- The Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, UK
| | | | - Kelvin Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Dechen Choiphel
- Essential Medicine and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | | | - Brendon Kearney
- Faculty of Medicine, University of Adelaide, Adelaide, SA, Australia
- Health Policy Advisory Committee on Technology, Brisbane, QLD, Australia
| | - Yuehua Liu
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raoh-Fang Pwu
- Taiwan National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Arsul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Binyan Sui
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Auliya Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Sean Tunis
- Center for Medical Technology Policy (CMTP), Baltimore, MD, USA
| | - Hui-Min Wu
- Taiwan National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - John Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
| | - Kun Zhao
- China Health Technology Assessment Centre, National Health Development Research Centre, Ministry of Health, Beijing, China
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
- Centre for Excellence in Economic Analysis Research, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore (NUS), Singapore, Singapore
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Jyani G, Prinja S, Garg B, Kaur M, Grover S, Sharma A, Goyal A. Health-related quality of life among Indian population: The EQ-5D population norms for India. J Glob Health 2023; 13:04018. [PMID: 36799239 PMCID: PMC9936451 DOI: 10.7189/jogh.13.04018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background The EuroQol 5 dimensions (EQ-5D) is the most used generic health-related quality of life (HRQoL) instrument for measuring population health and health outcomes. Since there are no EuroQol 5 dimensions 5 levels (EQ-5D-5L) population norms available for India, this study developed the Indian population norms for the EQ-5D-5L. The potential influencing factors of HRQoL of the Indian population have been identified. Methods The data was collected alongside the Indian EQ-5D-5L valuation study (Development of an EQ-5D Value Set for India Using an Extended Design: DEVINE Study). A cross-sectional survey of 3548 adult respondents was conducted across five states of India, in which respondents were asked to report their own health states using the EQ-5D-5L descriptive system and the EuroQol Visual Analog Scale (EQ VAS). The utility score was calculated using the EQ-5D-5L value set based on the preferences of the Indian population. Norm scores were generated for age, sex, and other important socio-demographic variables. The proportion of patients reporting problems in different dimensions of EQ-5D-5L was assessed. The impact of socio-economic determinants on health-related quality of life was evaluated using multiple linear regression. Results The mean EQ VAS score of the Indian population is 75.18 (95% confidence interval (CI) = 74.50-75.90), whereas mean utility score is 0.848 (95% CI = 0.840-0.857). The EQ VAS scores, and utility scores decreased with age. Males reported higher EQ VAS values than females. The highest mean utility score was observed for males of <20 years (0.936), whereas the lowest mean score was observed for females of >70 years (0.488). The mean VAS score ranged between 85.24 for females of <20 years and 50.67 for females of >70 years. Highest problems were reported in the dimension of "pain / discomfort", closely followed by "anxiety / depression". Age, educational qualification, marital status, substance abuse, presence of ailments, state / region of residence, number of dependent members in the household, and time spent on mobile are the significant determinants of HRQoL of Indian population. Conclusions These population norms will be used as reference values for comparative purposes in future Indian studies. Economic evaluations can use these average age-specific HRQoL population norms to value the health-state of not having the specific disease under investigation.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Basant Garg
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Chugh Y, Jyani G, Trivedi M, Albert S, Kar SS, Patro B, Raman S, Rajsekar K, Baker RM, Donaldson C, Prinja S. Protocol for estimating the willingness-to-pay-based value for a quality-adjusted life year to aid health technology assessment in India: a cross-sectional study. BMJ Open 2023; 13:e065591. [PMID: 36797026 PMCID: PMC9936284 DOI: 10.1136/bmjopen-2022-065591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION To ensure that the evidence generated by health technology assessment (HTA) is translated to policy, it is important to generate a threshold value against which the outcomes of HTA studies can be compared. In this context, the present study delineates the methods that will be deployed to estimate such a value for India. METHODS AND ANALYSIS The proposed study will deploy a multistage sampling approach considering economic and health status for selection of states, followed by selection of districts based on Multidimensional Poverty Index (MPI) and identification of primary sampling units (PSUs) using the 30-cluster approach. Further, households within PSU will be identified using systematic random sampling and block randomisation based on gender will be done to select respondent from the household. A total of 5410 respondents will be interviewed for the study. The interview schedule will comprise of three sections including background questionnaire to elicit socioeconomic and demographic characteristics, followed by assessment of health gains, and willingness to pay (WTP). To assess the health gains and corresponding WTP, the respondent will be presented with hypothetical health states. Using time trade off method, the respondent will indicate the amount of time he/she is willing to give up at the end of life to avoid morbidities in the hypothetical health condition. Further, respondents will be interviewed about their WTP for treatment of respective hypothetical conditions using contingent valuation technique. These estimates of health gains and corresponding WTP will then be combined to ascertain the value of WTP per quality-adjusted life year. ETHICS AND DISSEMINATION The ethical approval has been obtained from the Institutional Ethics Committee (IEC) of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study outcomes will be made available for general use and interpretation of HTA studies commissioned by India's central HTA Agency.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Mayur Trivedi
- Indian Institute of Public health, Gandhinagar, Gujarat, India
| | - Sandra Albert
- Indian Institutes of Public Health, Shillong, Meghalaya, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, JIPMER, Pondicherry, Pondicherry, India
| | - Binod Patro
- Department of Community Medicine & Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Orissa, India
| | - Swati Raman
- Academy of Management Sciences, Lucknow, Uttar Pradesh, India
| | - Kavitha Rajsekar
- Department of Health Research, India Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | - Rachel Mairi Baker
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Cam Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Baranwal AK, Prinja S, Kaur N. Congenital Heart Disease: Would It Be the Key Driver of Infant Survival During Amrit Kaal (2022-2047)? Indian Pediatr 2023; 60:98-102. [PMID: 36786178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Post-independence, we made significant strides in childhood survival. However, there is an abysmal improvement in survival due to birth defects. Globally, India contributes the largest proportion of under-5 deaths, overall as well as due to birth defects. Congenital heart disease (CHD) is the single most common cause of birth-defect related deaths, and is the 7th most common cause of infant deaths. Scarcity of pediatric cardiac care professionals and pediatric cardiac centers has led to a huge demand-supply gap. Understanding the burden of CHD and taking imperative steps at primary, secondary and tertiary levels are essential during Amrit Kaal (2022-2047). Coverage of management of CHD under Janani Shishu Suraksha Karyakram, Rashtriya Bal Suraksha Karyakram and Ayushman Bharat programs offers a huge promise, as shown by the experience from Hridayam program in Kerala.
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Affiliation(s)
- Arun K Baranwal
- Department of Pediarics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh. Correspondence to: Prof Arun Kumar Baranwal, HDF Unit, Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh 160 012.
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Navpreet Kaur
- Department of Pediarics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh
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Prinja S, Singh MP, Aggarwal V, Rajsekar K, Gedam P, Goyal A, Bahuguna P. Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective. Lancet Reg Health Southeast Asia 2023; 9:100123. [PMID: 37383034 PMCID: PMC10305929 DOI: 10.1016/j.lansea.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/04/2022] [Accepted: 11/21/2022] [Indexed: 06/30/2023]
Abstract
Background Districts hospitals in India play a pivotal role in delivering health care services in the public sector and are empanelled under India's national health insurance scheme i.e. Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY). In this paper, we evaluate the extent to which the PMJAY impacts the district hospitals from a financing perspective. Methods We used cost data from India's nationally representative costing study-'Costing of Health Services in India' (CHSI) to determine the incremental cost of treating PMJAY patients, after adjusting for resources that are paid through supply-side government financing route. Second, we used data on number and claim value paid to public district and sub-district hospitals during 2019, to determine the additional revenue generated through PMJAY. The annual net financial gain per district hospital was estimated as the difference between payments under PMJAY, and the incremental cost of delivering the services. Findings At current levels of utilisation, the district hospitals in India gain a net annual financial benefit of $ 26.1 (₹ 1839.3) million, which can potentially increase up to $ 41.8 (₹ 2942.9) million with an increase in the share of patient volume. For an average district hospital, we estimate net annual financial gain of $ 169,607 (₹ 11.9 million), increasing up to $ 271,372 (₹ 19.1 million) per hospital with increased utilisation. Interpretation Demand-side financing mechanisms can be used to strengthen the public sector. Increasing utilisation of district hospitals, by either gatekeeping or improving availability of services will enhance financial gains for district hospitals and strengthen public sector. Funding Department of Health Research, Ministry of Health & Family Welfare, Government of India.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- National Health Authority, Government of India, New Delhi, India
| | - Maninder Pal Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vipul Aggarwal
- National Health Authority, Government of India, New Delhi, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Praveen Gedam
- National Health Authority, Government of India, New Delhi, India
| | - Aarti Goyal
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Gupta D, Singh A, Gupta N, Mehra N, Bahuguna P, Aggarwal V, Krishnamurthy MN, Roy PS, Malhotra P, Gupta S, Kumar L, Kataki A, Prinja S. Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India. JCO Glob Oncol 2023; 9:e2200246. [PMID: 36795991 PMCID: PMC10166401 DOI: 10.1200/go.22.00246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Tyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India. METHODS A Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis. RESULTS We estimated the total lifetime cost per patient of ₹ 0.27 million ($3,706 US dollars [USD]), ₹ 0.35 million ($4,716 USD), ₹ 9.7 million ($131,858 USD), and ₹ 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of ₹ 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (₹ 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (₹ 168,300) in the Indian context. CONCLUSION Our findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.
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Affiliation(s)
- Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Vipul Aggarwal
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amal Kataki
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Chugh Y, Bahuguna P, Sohail A, Rajsekar K, Muraleedharan VR, Prinja S. Development of a Health Technology Assessment Quality Appraisal Checklist (HTA-QAC) for India. Appl Health Econ Health Policy 2023; 21:11-22. [PMID: 36260276 PMCID: PMC9579659 DOI: 10.1007/s40258-022-00766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aim to develop a comprehensive checklist for evaluating Health Technology Assessment (HTA) studies commissioned in India. The primary objective of this work is to capture all vital aspects of an HTA study in terms of conduct, reporting and quality. METHODOLOGY The development of a quality appraisal checklist included 3 steps. First, a targeted review of the literature was done to gather information on existing HTA checklists. After reviewing these checklists, an initial draft of the HTA quality appraisal checklist (HTA-QAC) for India was prepared with discussion amongst the authors. Second, the draft checklist was reviewed by the members of the Technical Appraisal Committee (TAC) and their feedback was incorporated. Subsequently, the revised checklist was presented at a virtual meeting of the TAC. Finally, a pilot phase was undertaken to apply HTA-QAC for the approved HTA study reports. Three rounds of virtual discussions were held with the researchers who were involved in the conduct of these HTA studies to resolve any discordance in opinion or develop solutions for the problems in the use of the HTA-QAC followed by a further revision of the checklist. RESULTS The HTA-QAC is divided into two parts: a self-reporting section to be completed by the author, and the other to be completed by the reviewer. The reviewer checklist has two sections: one to review the report and the other to review the model. The author section is in a self-reporting format, which includes details of basic study information, the rationale for the study, policy relevance, study description, study methods, reporting of model parameters, and results. The reviewer section of the checklist focuses on the quality aspect of the conducted study. The domains included in the report review include details on study methodology, results, discussion, and conclusion. The second part of the reviewer section of HTA-QAC constitutes a review of the model in terms of model assumptions, functionality, model inputs, calculations, uncertainty analysis, model output, and model validation. CONCLUSION We recommend a standardised process of quality appraisal to ensure the high quality of HTA evidence for policy use in the Indian context. The proposed HTA-QAC will help authors to ensure standardised reporting, as well as allow reviewers to assess the quality of analysis.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Aamir Sohail
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - V R Muraleedharan
- Centre for Technology and Policy, Indian Institute of Technology, Chennai, Tamil Nadu, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
- Government of India, National Health Authority, New Delhi, India.
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Prinja S, Sharma A, Nadipally S, Rana SK, Bahuguna P, Rao N, Chakraborty G, Shankar M, Rai V. Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol. Int J Mycobacteriol 2023; 12:82-91. [PMID: 36926768 DOI: 10.4103/2212-5531.307071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background A. "pay-for-performance" (P4P) intervention model for improved tuberculosis (TB) outcomes, called "Mukti," has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach. Methods Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups. Results The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country. Discussion The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Nadipally
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Neeta Rao
- US Agency for International Development, New Delhi, India
| | | | - Manjunath Shankar
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Varsha Rai
- State TB Office, National Tuberculosis Elimination Program, Government of Madhya Pradesh, India
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Sharma A, Prinja S, Rao KD, Aggarwal AK. Human Resources for Health in Haryana, India: What can be Done Better? WHO South East Asia J Public Health 2023; 12:4-14. [PMID: 37843177 DOI: 10.4103/who-seajph.who-seajph_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction Health systems in developing countries suffers from both input and productivity issues. We examined the status of three domains of human resources for health, i.e., availability and distribution, capacity and productivity, and motivation and job-satisfaction, of the health-care workforce employed in the public health system of Haryana, a North Indian state. Methodology The primary data were collected from 377 public health facilities and 1749 healthcare providers across 21 districts. The secondary data were obtained from government reports in the public domain. Bivariate and multivariate statistical techniques were used for evaluating district performances, making inter-district comparisons and identifying determinants of motivation and job-satisfaction of the clinical cadres. Results We found 3.6 core health-care workers (doctors, staff nurses, and auxiliary nurses-midwives) employed in the public health-care system per 10,000 population, ranging from 1.35 in Faridabad district to 6.57 in Panchkula district. Around 78% of the sanctioned positions were occupied. A number of inpatient hospitalizations per doctor/nurses per month were 17 at the community health center level and 29 at the district hospital level; however, significant differences were observed among districts. Motivation levels of community health workers (85%) were higher than clinical workforce (78%), while health system administrators had lowest motivation and job satisfaction levels. Posting at primary healthcare facility, contractual employment, and co-habitation with family at the place of posting were found to be the significant motivating factors. Conclusions A revamp of governance strategies is required to improve health-care worker availability and equitable distribution in the public health system to address the observed geographic variations. Efforts are also needed to improve the motivation levels of health system administrators, especially in poorly performing districts and reduce the wide gap with better-off districts.
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Affiliation(s)
- Atul Sharma
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Dipankar Rao
- Centre for Global Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arun Kumar Aggarwal
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bahuguna P, Masaki E, Jeet G, Prinja S. Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective. Appl Health Econ Health Policy 2023; 21:131-140. [PMID: 36136264 PMCID: PMC9492462 DOI: 10.1007/s40258-022-00763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION A comprehensive package of immunization services is an internal component of the Essential Health Service Package (ESP) implemented by Government of Lao People's Democratic Republic (Lao PDR). Thus, the cost of delivering the immunization program and its feasibility given the fiscal space emerges as an important policy question. The present analysis was undertaken to estimate the total cost of implementing the immunization program under ESP, determinants of total cost and the program's fiscal implications from the government's perspective. METHODOLOGY We employed a normative costing approach for costing of immunization services under ESP. Standard treatment guidelines (STGs) from both within and outside Lao PDR were considered to identify the resource use for each vaccine delivery. Subsequently, cost per dose administered and fully immunized beneficiary were computed. We assessed the fiscal space for financing immunization services in Lao PDR by adapting the decomposition method given by Tandon et al. RESULTS: In 2019, the estimated total cost of financing immunization in Lao PDR was US$12 million, which will increase in 2025 by 1.75 times, to US$21 million. The per capita budget for immunization needs to increase from about US$2 to US$7. Introduction of newer vaccines in the immunization schedule accounts for the major share (60%) of the increased cost for financing immunization. In view of current fiscal space, the government immunization expenditure (GIE) allocations will be adequate only in a scenario where no new vaccine is introduced under ESP in future years. CONCLUSION The current fiscal space would fall short of meeting the aspirational goals of ESP-Immunization for the introduction of newer vaccines in Lao PDR. The present analysis of the fiscal space provides important evidence to support a greater role for the Global Alliance for Vaccine Initiative (GAVI) to continue to finance immunization in Lao PDR. A publicly financed immunization model in Lao PDR would require significant strategic amendments with low short-term viability.
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Affiliation(s)
- Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emiko Masaki
- Health, Nutrition and Population, World Bank, Vientiane, Lao PDR
| | - Gursimer Jeet
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Singh MP, Popli R, Brar S, Rajsekar K, Sachin O, Naik J, Kumar S, Sinha S, Singh V, Patel P, Verma R, Hazra A, Misra R, Mehrotra D, Biswal SB, Panigrahy A, Gaur KL, Pankaj JP, Sharma DK, Madhavi K, Madhusudana P, Narayanasamy K, Chitra A, Velhal GD, Bhondve AS, Bahl R, Kaur S, Prinja S. CHSI costing study-Challenges and solutions for cost data collection in private hospitals in India. PLoS One 2022; 17:e0276399. [PMID: 36508431 PMCID: PMC9744278 DOI: 10.1371/journal.pone.0276399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Government of India to become a strategic purchaser of health care services from private providers. To generate base cost evidence for evidence-based policymaking the Costing of Health Services in India (CHSI) study was commissioned in 2018 for the price setting of health benefit packages. This paper reports the findings of a process evaluation of the cost data collection in the private hospitals. METHODS The process evaluation of health system costing in private hospitals was an exploratory survey with mixed methods (quantitative and qualitative). We used three approaches-an online survey using a semi-structured questionnaire, in-depth interviews, and a review of monitoring data. The process of data collection was assessed in terms of time taken for different aspects, resources used, level and nature of difficulty encountered, challenges and solutions. RESULTS The mean time taken for data collection in a private hospital was 9.31 (± 1.0) person months including time for obtaining permissions, actual data collection and entry, and addressing queries for data completeness and quality. The longest time was taken to collect data on human resources (30%), while it took the least time for collecting information on building and space (5%). On a scale of 1 (lowest) to 10 (highest) difficulty levels, the data on human resources was the most difficult to collect. This included data on salaries (8), time allocation (5.5) and leaves (5). DISCUSSION Cost data from private hospitals is crucial for mixed health systems. Developing formal mechanisms of cost accounting data and data sharing as pre-requisites for empanelment under a national insurance scheme can significantly ease the process of cost data collection.
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Affiliation(s)
- Maninder Pal Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Riya Popli
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sehr Brar
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Jyotsna Naik
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sanjay Kumar
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Setu Sinha
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Varsha Singh
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Prakash Patel
- Surat Municipal Institute of Medical Education & Research, Surat, Gujarat, India
| | - Ramesh Verma
- Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Avijit Hazra
- Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India
| | - Raghunath Misra
- Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India
| | - Divya Mehrotra
- King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sashi Bhusan Biswal
- Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Ankita Panigrahy
- Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | | | | | | | - Kondeti Madhavi
- Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India
| | | | | | - A. Chitra
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | - Amit S. Bhondve
- Seth G S Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Rakesh Bahl
- Government Medical College, Jammu, Jammu & Kashmir, India
| | | | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- National Health Authority, Government of India, New Delhi, India
- * E-mail:
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Chauhan AS, Guinness L, Bahuguna P, Singh MP, Aggarwal V, Rajsekhar K, Tripathi S, Prinja S. Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment. BMC Health Serv Res 2022; 22:1343. [PMCID: PMC9664599 DOI: 10.1186/s12913-022-08707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
AbstractThe 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors.A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location.The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification).The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.
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Sirari T, Suthar R, Singh A, Prinja S, Gupta V, Malviya M, Chauhan AS, Sankhyan N. Development and economic evaluation of a patient-centered care model for children with Duchenne’s Muscular Dystrophy: A quasi-experimental study protocol (Preprint). JMIR Res Protoc 2022; 12:e42491. [PMID: 37115592 PMCID: PMC10182458 DOI: 10.2196/42491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare progressive muscular disease that primarily affects boys. A lack of comprehensive care for patients living with DMD is directly associated with a compromised quality of life (QoL) for those affected and their caregivers. This disease also has a huge economic impact on families as its treatment requires substantial direct, indirect, and informal care costs. OBJECTIVE This study presents a protocol developed to evaluate the feasibility and efficacy of a patient-centered care (PCC) model for children with DMD. The care model was designed with the aim to empower families, improve QoL, and reduce economic burden on their families. METHODS This study is planned as a quasi-experimental study that will enroll 70 consecutive families with boys (aged 5-15 years) with DMD visiting a tertiary care center. The study is being conducted in 2 phases (preintervention and postintervention phases, referred to as phase 1 and phase 2, respectively). During phase 1, the patients received routine care. The study is now in phase 2, with the intervention currently being administered. The intervention is based on the PCC model individualized by the intervention team. The model has a comprehensive DMD telecare component that includes teleconsultation as one of its key components to reduce in-person physician visits at the health facility. Teleconsultation is especially beneficial for late-ambulatory and nonambulatory patients. Data on economic burden are being collected for out-of-pocket expenses for both phases during in-person visits via telephone or messaging apps on a monthly basis. QoL data for patients and their primary caregivers are being collected at 3 time points (ie, time of enrollment, end of phase 1, and end of phase 2). Outcome measures are being assessed as changes in economic burden on families and changes in QoL scores. RESULTS Participant recruitment began in July 2021. The study is ongoing and expected to be completed by March 2023. The findings based on baseline data are expected to be submitted for publication in 2023. CONCLUSIONS This paper outlines a research proposal developed to study the impact of a PCC model for patients with DMD in low- and middle-income countries (LMICs). This study is expected to provide evidence of whether a multicomponent, patient-centric intervention could reduce economic burdens on families and improve their QoL. The results of this study could guide policy makers and health professionals in India and other LMICs to facilitate a comprehensive care program for patients living with DMD. The economic impact of a rare disease is an important consideration to formulate or evaluate any health policy or intervention related to new treatments and financial support schemes. TRIAL REGISTRATION Clinical Trials Registry India (ICMR-NIMS) CTRI/2021/06/034274; https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=56650. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42491.
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Affiliation(s)
- Titiksha Sirari
- Lovely Professional University, Phagwara, India
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Community Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Shankar Prinja
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishwas Gupta
- Lovely Professional University, Phagwara, India
- Symbiosis Centre for Management Studies, Noida, Uttar Pradesh, India
| | - Manisha Malviya
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta N, Chugh Y, Chauhan AS, Pramesh C, Prinja S. Cost-effectiveness of Post-Mastectomy Radiotherapy (PMRT) for breast cancer in India: An economic modelling study. Lancet Reg Health Southeast Asia 2022; 4:100043. [PMID: 37383992 PMCID: PMC10306019 DOI: 10.1016/j.lansea.2022.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background The role of post-mastectomy radiotherapy (PMRT) for breast cancer is controversial when 3-or-less lymph nodes are metastatic. Apart from local control, survival and toxicity, cost also plays an important role in decision-making. Methods A Markov model was designed to assess cost, health outcomes and cost-effectiveness of different radiotherapy techniques for management of PMRT patients. Thirty-nine scenarios were modelled based on type of radiotherapy, laterality, pathologic nodal burden, and dose fractionation. We considered a societal perspective, lifetime horizon and a 3% discount rate. The data on quality of life (QoL) was derived using the cancer database on cost and QoL. Published data on cost of services delivered in India were used. Findings Post-mastectomy radiotherapy results in incremental quality adjusted life years (QALYs) that ranged from -0.1 to 0.38 across different scenarios. The change in cost ranged from estimated median savings of USD 62 (95% confidence intervals: -168 to -47) to incurring an incremental cost of USD 728 (650-811) across different levels of nodal burden, breast laterality and dose fractionation. For women with node-negative disease, disease-specific systemic therapy remains to be the preferred strategy. For women with node-positive disease, two-dimensional radiotherapy (2DRT) with hypofractionation is the most cost-effective strategy. However, a CT based planning is preferred when maximum heart distance (MHD) >1cm, irregular chest wall contour and inter-field separation >18cm. Interpretation PMRT is cost-effective for all node-positive patients. With similar toxicity and effectiveness profile compared with conventional fractionation, moderate hypofractionation significantly reduces the cost of treatment and should be the standard of care. Conventional techniques for PMRT are cost-effective over newer modalities which provide minimal additional benefit, at high cost. Funding The funding to collect primary data for study was provided by Department of Health Research, Ministry of Health and Family Welfare, New Delhi, wide letter number F. No. T.11011/02/2017-HR/3100291.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C.S. Pramesh
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
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Singh MP, Prinja S, Rajsekar K, Gedam P, Aggarwal V, Sachin O, Naik J, Agarwal A, Kumar S, Sinha S, Singh V, Patel P, Patel AC, Joshi R, Hazra A, Misra R, Mehrotra D, Biswal SB, Panigrahy A, Gaur KL, Pankaj JP, Sharma DK, Madhavi K, Madhusudana P, Narayanasamy K, Chitra A, Velhal GD, Bhondve AS, Bahl R, Sachdeva A, Kaur S, Nagar A, Bhargava B. Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes. Pharmacoecon Open 2022; 6:745-756. [PMID: 35733075 PMCID: PMC9216290 DOI: 10.1007/s41669-022-00342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals. METHODS The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs. RESULTS At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair. CONCLUSIONS Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.
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Affiliation(s)
- Maninder Pal Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India.
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Praveen Gedam
- National Health Authority, Government of India, New Delhi, India
| | - Vipul Aggarwal
- National Health Authority, Government of India, New Delhi, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Jyotsna Naik
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajai Agarwal
- National Health Authority, Government of India, New Delhi, India
| | - Sanjay Kumar
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Setu Sinha
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Varsha Singh
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Prakash Patel
- Surat Municipal Institute of Medical Education & Research, Surat, Gujarat, India
| | - Amit C Patel
- Surat Municipal Institute of Medical Education & Research, Surat, Gujarat, India
| | - Rajendra Joshi
- Surat Municipal Institute of Medical Education & Research, Surat, Gujarat, India
| | - Avijit Hazra
- Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India
| | - Raghunath Misra
- Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India
| | - Divya Mehrotra
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sashi Bhusan Biswal
- Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Ankita Panigrahy
- Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | | | | | | | - Kondeti Madhavi
- Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India
| | | | | | - A Chitra
- Madras Medical College, Chennai, Tamil Nadu, India
| | - Gajanan D Velhal
- Seth G S Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Amit S Bhondve
- Seth G S Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Rakesh Bahl
- Government Medical College, Jammu, Jammu & Kashmir, India
| | - Amit Sachdeva
- Government Medical College, Jammu, Jammu & Kashmir, India
| | | | - Anu Nagar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
- Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Chauhan AS, Prinja S, Selvaraj S, Gupta A, Muraleedharan VR, Sundararaman T. Cost of delivering primary healthcare services through public sector in India. Indian J Med Res 2022; 156:372-380. [PMID: 36588362 PMCID: PMC10101352 DOI: 10.4103/ijmr.ijmr_67_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background & objectives Public health spending on primary healthcare has increased by four times (in real terms) over the last decade and continues to constitute more than half of the total public health expenditure. The present study estimated the cost of providing healthcare services at sub centre (SC) and primary health centre (PHC) level in four selected States of India. Methods A total of 51 SCs and 33 PHCs were selected across the four States (Himachal Pradesh, Odisha, Kerala and Tamil Nadu) of India. The economic cost of delivering health services at these facilities was assessed using bottom-up costing methodology during the reference year of 2014-2015. The cost of capital items was annualized and allocation of shared resources was based on appropriate apportioning statistics. Results The mean annual cost of providing health services at SC and PHC was ₹ 0.69 million (US$ 11,392) and ₹ 5.1 million (US$ 83,837), respectively. Nearly 3/4th and 2/3rd of this cost at the level of SC (74%) and PHC (63%) were spent on salaries. In terms of unit cost, the costs per antenatal care and postnatal care visit were ₹ 221 (173-276) and ₹ 333 (244-461), respectively, at SCs. Similarly, the costs of per patient outpatient consultation and per bed day hospitalization at PHC level were ₹ 121 (91-155) and ₹ 1168 (955-1468), respectively. Interpretation & conclusions The cost estimates from the present study can be used in economic evaluations, assessing technical efficiency and also for providing valuable information during scale-up of health facilities.
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Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sakthivel Selvaraj
- Department of Health Economics, Financing and Policy, Public Health Foundation of India, New Delhi, India
| | - Aditi Gupta
- Department of Family Planning, Jhpiego India Country Office, New Delhi, India
| | - V R Muraleedharan
- Department of Humanities & Social Sciences, Indian Institute of Technology - Madras, Chennai, Tamil Nadu, India
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Vassall A, Sweeney S, Barasa E, Prinja S, Keogh-Brown MR, Tarp Jensen H, Smith R, Baltussen R, M Eggo R, Jit M. Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries. Wellcome Open Res 2022; 5:272. [PMID: 36081645 PMCID: PMC9433912 DOI: 10.12688/wellcomeopenres.16380.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Covid-19 requires policy makers to consider evidence on both population health and economic welfare. Over the last two decades, the field of health economics has developed a range of analytical approaches and contributed to the institutionalisation of processes to employ economic evidence in health policy. We present a discussion outlining how these approaches and processes need to be applied more widely to inform Covid-19 policy; highlighting where they may need to be adapted conceptually and methodologically, and providing examples of work to date. We focus on the evidential and policy needs of low- and middle-income countries; where there is an urgent need for evidence to navigate the policy trade-offs between health and economic well-being posed by the Covid-19 pandemic.
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Affiliation(s)
- Anna Vassall
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Sedona Sweeney
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Kenya and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marcus R Keogh-Brown
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Henning Tarp Jensen
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rob Baltussen
- Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - Rosalind M Eggo
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
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Prinja S, Kumar S, Sharma A, Kar SS, Tripathi N, Dumka N, Sharma S, Mukhopadhyay I, Rana SK, Garg S, Kotwal A, Aggarwal AK. What is the Out-of-Pocket Expenditure on Medicines in India? An Empirical Assessment using a Novel Methodology. Health Policy Plan 2022; 37:1116-1128. [PMID: 35862250 DOI: 10.1093/heapol/czac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 11/14/2022] Open
Abstract
The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicines expenditure using a novel methodology. OOP expenditure data were collected through exit-interviews with 5252 out-patient department (OPD) patients in three states of India. Follow-up interviews were conducted after day 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using patient-reported versus imputation-based method (30.74% to 29.61%). Large reductions were observed for single-doctor clinics, especially in case of Ayurvedic (64.51% to 36.51%) and Homeopathic (57.53% to 42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in reported share of medicines for public and private sector out-patient consultations respectively, as compared to facility based exit interviews with imputation of expenditure for medicines as per actual quantity and price data. The nature of health care transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicines expenditure.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Sumit Kumar
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Neha Dumka
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Sandeep Sharma
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Indranil Mukhopadhyay
- School of Government and Public Policy, OP Jindal Global University, Sonipat, Haryana, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Atul Kotwal
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Dixit J, Brar S, Prinja S. Burden of Group A Streptococcal Pharyngitis, Rheumatic Fever, and Rheumatic Heart Disease in India: A Systematic Review and Meta-Analysis. Indian J Pediatr 2022; 89:642-650. [PMID: 34379301 DOI: 10.1007/s12098-021-03845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the burden of group A streptococcal pharyngitis (GAS) pharyngitis, rheumatic fever (RF), and rheumatic heart disease (RHD) in India using existing data sources, as well as to recognize the most serious gaps in GAS disease burden data. METHODS Four electronic databases-PubMed, Scopus, Embase, and Web of Science were searched using a comprehensive search strategy. Data were identified primarily from observational studies including school surveys, community-based and hospital-based studies. The standard methodological procedures as per Cochrane guidelines were used. Eligible studies were pooled for estimating prevalence, incidence, and case fatality rate using R software version 3.3.3. The protocol was registered with PROSPERO; registration number CRD42018075742. RESULTS The pooled prevalence of GAS pharyngitis among asymptomatic children and pharyngitis cases aged 5 to 15 y was estimated as 2.79 percent [95% Confidence interval (CI): 1.58-4.89] and 13 percent (95% CI: 3.18-41.97), respectively. The prevalence rate of rheumatic fever was found to be 0.04% (95% CI: 0.01-0.17). The pooled prevalence rate of RHD among children aged 5-15 y using clinical auscultation and echocardiography was estimated as 0.36 percent (95% CI: 0.02-7.52) and 0.28 percent (95% CI: 0.08-1.03), respectively. CONCLUSION The study emphasizes the importance of developing a population-based surveillance framework to track patterns, management strategies, and outcomes in order to develop informed recommendations for launching contextual measures to regulate RF and RHD.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sehr Brar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Jyani G, Sharma A, Prinja S, Kar SS, Trivedi M, Patro BK, Goyal A, Purba FD, Finch AP, Rajsekar K, Raman S, Stolk E, Kaur M. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value Health 2022; 25:1218-1226. [PMID: 35779943 DOI: 10.1016/j.jval.2021.11.1370] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare. METHODS A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set. RESULTS A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension. CONCLUSIONS This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.
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Affiliation(s)
- Gaurav Jyani
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sitanshu Sekhar Kar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, India
| | | | - Aarti Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Indonesia
| | | | - Kavitha Rajsekar
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Swati Raman
- Academy of Management Studies, Lucknow, India
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta N, Gupta D, Dixit J, Mehra N, Singh A, Krishnamurthy MN, Jyani G, Rajsekhar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Malhotra P, Gupta S, Kumar L, Kataki A, Prinja S. Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women. Appl Health Econ Health Policy 2022; 20:609-621. [PMID: 35534752 DOI: 10.1007/s40258-022-00731-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In this study, we evaluate the cost and outcomes of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) plus fulvestrant, fulvestrant alone, and conventional chemotherapy as the second-line therapy for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in India. METHODS Using a Markov model, the clinical effectiveness of managing HR+, HER2- MBC in postmenopausal women with either a CDK4/6i (either ribociclib or palbociclib) and fulvestrant, fulvestrant alone, and chemotherapy (single-agent paclitaxel or capecitabine) was measured in terms of quality-adjusted life-years (QALYs). The costs were estimated from two different points of view: scenario I, as per the prevailing market prices of the drugs; and scenario II, as per the reimbursement rates set up by the publicly financed national health insurance scheme. Incremental cost per QALY gained with a given treatment option was compared against the next best alternative and was assessed for cost effectiveness using a threshold of 1-time the per capita gross domestic product (GDP) in India from a societal perspective. RESULTS In scenario I, an MBC patient was found to incur a lifetime cost of Indian Rupees (₹) 2.54 million ($34,644), ₹2.53 million ($34,496), ₹512,598 ($6,984), ₹326,026 ($4,442) and ₹237,115 ($3,230) for the ribociclib and palbociclib combination arms, fulvestrant monotherapy, single-agent paclitaxel and the single-agent capecitabine treatment arms, respectively. The lifetime cost for CDK4/6i (ribociclib and palbociclib) combination therapy, fulvestrant monotherapy, paclitaxel, and capecitabine arms was estimated to be ₹1.94 million ($26,459), ₹1.92 million ($26,220), ₹315,387 ($4,296), ₹187,392 ($2,553) and ₹153,263 ($2,088), respectively, in scenario II. The mean QALYs lived per MBC patient with CDK4/6i (either ribociclib or palbociclib) combination therapy, fulvestrant, paclitaxel and capecitabine were estimated to be 1.4, 1.0, 0.9 and 0.7, respectively. None of the treatment arms are cost effective at current prices and reimbursement rates at a threshold of 1-time the per capita GDP of India. However, a 78% reduction in the current market price or a 72% reduction in the reimbursement rate of fulvestrant in the government-funded insurance program will make it a cost-effective treatment option for HR+, HER2- MBC patients in India. CONCLUSION CDK4/6i (ribociclib and palbociclib) therapy is not a cost-effective treatment option for MBC patients. A 72% reduction in the reimbursement rate for fulvestrant monotherapy will make it a cost-effective treatment option in the Indian context.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amal Kataki
- Department of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Singh M, Sharma A, Bahuguna P, Jyani G, Prinja S. Cost-effectiveness analysis of 'test and treat' policy for antiretroviral therapy among heterosexual HIV population in India. Indian J Med Res 2022; 156:705-714. [PMID: 37056069 DOI: 10.4103/ijmr.ijmr_806_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background & objectives The World Health Organisation recommended immediate initiation of antiretroviral therapy (ART) in all adult human immunodeficiency virus (HIV) patients regardless of their CD4 cell count. This study was undertaken to ascertain the cost-effectiveness of implementation of these guidelines in India. Methods A Markov model was developed to assess the lifetime costs and health outcomes of three scenarios for initiation of ART treatment at varying CD4 cell count <350/mm[3], <500/mm[3] and test and treat using health system perspective using life-time horizon. A few input parameters for this model namely, transition probabilities from one stage to another stage of HIV and incidence rates of TB were calculated from the data of Centre of Excellence for HIV treatment and care, Chandigarh; whereas, other parameters were obtained from the published literature. Total HIV-related deaths averted, HIV infections averted and incremental cost-effectiveness ratio per quality adjusted life years (QALYs) gained were calculated. Result Test and treat intervention slowed down the progression of disease and averted 18,386 HIV-related deaths, over lifetime horizon. It also averted 16,105 new HIV infections and saved 343,172 QALYs as compared to the strategy of starting ART at CD4 cell count of 500/mm[3]. Incremental cost per QALY gained for the immediate initiation of ART as compared to ART at CD4 cell count of 500/mm[3] and 350/mm[3] was ₹ 46,599 and 80,050, respectively at reported rates of adherence to the therapy. Interpretation & conclusions Immediate ART (test and treat) is highly cost-effective strategy over the past criteria of delayed therapy in India. Cost-effectiveness of this policy is largely because of reduction in the transmission of HIV.
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Affiliation(s)
- Malkeet Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Purohit N, Chugh Y, Bahuguna P, Prinja S. COVID-19 Management: The Vaccination Drive in India. Health Policy and Technology 2022; 11:100636. [PMID: 35531441 PMCID: PMC9069978 DOI: 10.1016/j.hlpt.2022.100636] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022]
Abstract
Objective We undertook the study to present a comprehensive overview of COVID-19 related measures, largely centred around the development of vaccination related policies, their implementation and challenges faced in the vaccination drive in India. Methods A targeted review of literature was conducted to collect relevant data from official government documents, national as well as international databases, media reports and published research articles. The data were summarized to assess Indian government's vaccination campaign and its outcomes as a response to COVID-19 pandemic. Results The five-point strategy adopted by government of India was “COVID appropriate behaviour, test, track, treat and vaccinate”. With respect to vaccination, there have been periodic shifts in the policies in terms of eligible beneficiaries, procurement, and distribution plans, import and export strategy, involvement of private sector and use of technology. The government utilized technology for facilitating vaccination for the beneficiaries and monitoring vaccination coverage. Conclusion The monopoly of central government in vaccine procurement resulted in bulk orders at low price rates. However, the implementation of liberalized policy led to differential pricing and delayed achievement of set targets. The population preference for free vaccines and low profit margins for the private sector due to price caps resulted in a limited contribution of the dominant private health sector of the country. A wavering pattern was observed in the vaccination coverage, which was related majorly to vaccine availability and hesitancy. The campaign will require consistent monitoring for timely identification of bottlenecks for the lifesaving initiative.
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Singh LM, Siddhanta A, Singh AK, Prinja S, Sharma A, Sikka H, Goswami L. Potential Impact of the Insurance on Catastrophic Health Expenditures Among the Urban Poor Population in India. Journal of Health Management 2022. [DOI: 10.1177/09720634221088425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Urban poor face a disproportionate burden of ill health and high out-of-pocket expenditure (OOPE), creating a severe unmet need for affordable and quality health care. This article highlights the impact of health insurance on OOPE and catastrophic healthcare expenditure among the urban poor of India. Methods: The study uses randomly collected household data from a baseline survey conducted in the states of Rajasthan and Uttar Pradesh. Separate Insurance impact models have been generated for the analysis. Results: Mean out-of-pocket health expenses is higher in the private health facility for the inpatient care but in case of outpatient care, the expenditure was more in public. Expenditure on medicine constitutes the largest part of the total OOPE. Insurance impact model shows that coverage on medicine alone can reduce medical impoverishment by 85% in the case of Outpatient Deparment (OPD) and 71% in the case of Inpatient Department (IPD). The urban poor preferred private facility for treatment in case of illness, albeit when it comes to delivery, they prefer public facility Conclusions: Study findings indicate overt reliance on private health care must be regulated, to reduce OOPE among the urban poor. Also, effective universal health insurance can go a long way in reducing the OOPE with availability of free medicines and diagnostics in the public health facilities.
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Affiliation(s)
| | | | | | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gupta N, Nehra P, Chauhan AS, Mehra N, Singh A, Krishnamurthy MN, Rajsekhar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Malhotra P, Kataki AC, Dixit J, Gupta S, Kumar L, Prinja S. Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India-A Model-Based Economic Analysis. JCO Glob Oncol 2022; 8:e2100355. [PMID: 35286136 PMCID: PMC8932481 DOI: 10.1200/go.21.00355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Prerika Nehra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | | | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B. Booroah Cancer Institute, Guwahati, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amal Chandra Kataki
- Department of Gynaecologic Oncology, Dr B. Booroah Cancer Institute, Guwahati, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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