The impact of seven major noncommunicable diseases on direct medical costs, absenteeism, and presenteeism in Gulf Cooperation Council countries

Unraveling the future productivity burden of cardiovascular disease in Qatar: Investigating the modifiable risk factors control in type 2 diabetes

Aims

Insufficient risk factor control can lead to a loss of millions of productivity-adjusted life years (PALYs). We aimed to assess the productivity burden of cardiovascular disease (CVD) in type 2 diabetes (T2D) and examine the potential advantages of enhancing the control of modifiable CVD risk factors in Qatar.

Materials and methods

Models were developed to quantify the productivity burden, in terms of PALYs, of CVD in Qataris with T2D, aged 40-65 years, from 2024 to 2033. The financial value of PALYs was determined based on the gross domestic product (GDP) per full-time worker (i.e. US$80,573). The base-case model estimated the productivity burden of CVD, and interventional scenarios were simulated to assess potential gains resulting from improved control of modifiable risk factors, including reduced incidence of T2D, lower systolic blood pressure (SBP), decreased number of smokers, and reduced total cholesterol. All costs and outcomes were discounted at an annual rate of 3 %.

Results

The base-case analysis projected that CVD in T2D would result in an estimated 2,096,536 PALYs (95 % confidence interval, 1,689,272-2,182,939), contributing US$225.46 (95 %CI, 1,689,272-2,182,939) billion to the country's GDP. However, implementing interventions to decrease the T2D incidence, lower SBP, reduce the number of smokers, and improve the total cholesterol could yield gains of 200,408, 198,173, 194,725, and 113,462 PALYs, respectively. These improvements would also lead to economic gains of US$20.01 billion, US$20.17 billion, US$19.78, and US$12.79 billion, respectively.

Conclusions

Implementing interventions that prioritize risk factor control and prevention of CVD can help enhance overall productivity in the country.

Investing in Addressing NCDs and Mental Health Conditions: a Political Choice

Noncommunicable diseases (NCDs) and mental health conditions are responsible for 75% of deaths globally, with the greatest burden in low‑ and middle‑income countries (LMICs). The economic impact of NCDs and mental health conditions on households, health systems, and economies is also staggering. Despite the growing burden of NCDs, the available funding to address these diseases is limited, with less than 2.3% of global health development assistance spent on NCDs. The 2025 United Nations (UN) High‑Level Meeting on NCDs will provide a critical opportunity to reaffirm global commitments, enhance political will, and advocate for greater resource mobilization for the prevention and control of NCDs and mental health conditions. Investments will be needed in the strengthening of health systems, integrated models of care, multisectoral action, and a greater focus on vulnerable populations. Increased domestic and international funding will be required for implementation research as well, to ensure sustainable progress toward overcoming context‑specific barriers impeding the achievement of Sustainable Development Goals (SDG) target 3.4 on reducing premature mortality from NCDs and improving mental health and well‑being. The challenge remains to convert high‑level commitments into actionable, measurable strategies and mobilize the resources required to meet these goals, particularly in low‑income settings.

The development of the Saudi Billing System supporting national health transformation: methods and justification

BACKGROUND

The Saudi health transformation program entails a comprehensive reform of all health system functions. One of the pillars of this reform is the health care financing transformation. The Council of Health Insurance (CHI) aims to bring more transparency and understanding of case-mix through the introduction of patient classification and data standardization. Until recently, the private health insurance sector was using a variety of in-house non-standardized billing codes that impeded transparency and a value-based health care (VBHC) financing model. This study enabled the introduction of standardized billing codes known as the Saudi Billing System (SBS).

METHODS

We reviewed and assessed several patient classification and billing systems as part of the assessment phase, followed by data collection from the three largest health insurance companies relating to eighty health care providers. A representative sample of 36,299 patient records were re-coded. Coding was undertaken using the Australian Classification of Health Interventions (ACHI) 10th Edition. Codes were assigned based on assessment by clinical coders using an established methodology and followed by an audit to confirm the assigned code or assign an alternative code where the coding could not be adequately completed by the initial coder.

RESULTS

Seventy-five percent of records were mapped to an existing ACHI code, leaving 25% being a partial match, an approximate match or other (1%, 22% and 2% respectively). As part of this process, the original ACHI codes were modified, and additional codes were added, ensuring full compatibility with billing practices. We named the new code set the Saudi Billing System (SBS). As a result of this work, we created an additional 1,774 codes, bringing the total SBS code set to 7,947 codes (30% increase from ACHI 10th Edition).

CONCLUSIONS

Patient classification and standardized billing systems are critical for transparency in providing health care and financing. Working within the existing national patient classification mandate and clinical coding standards required innovative ways to adapt these systems to a private health insurance market (specificity, familiarity, existing license with modification rights and ability to build fee schedule), to address the requirements of a reformed and more value-based insurance market. Current mandated patient classification systems are a good basis for adaptation to serve the needs of the overall health care transformation in the country and a building block towards more transparency and VBHC.

Economic burden of Type 2 diabetes in Iran in 2022

BACKGROUND

Diabetes mellitus, particularly Type 2 diabetes (T2D), represents a significant global health challenge, with its prevalence steadily rising over the past few decades. This study was conducted with the aim of estimating the economic burden of T2D in Iran.

METHODS

This study employed a prevalence-based approach to estimate the economic burden of T2D and its attributable complications in adults above 20 years old in Iran for 2022. Both direct medical costs and indirect costs were considered in our analysis. Direct medical costs included inpatient and outpatient costs attributable to T2D and its complications, while indirect costs encompassed absenteeism, presenteeism, inability to work, and premature mortality costs due to the disease.

RESULTS

The findings showed that a total of 5,702,547 people, equivalent to 14.2% of Iranian adults, had T2D. The estimated total direct medical cost of T2D and its attributable complications in Iran in 2022 was 1,879.2 million US dollars (US$-PPP 6,676.9 million). Chronic kidney disease accounted for the largest proportion, followed by ischemic heart disease (IHD), and T2D itself. The total economic burden of T2D and its attributable complications in Iran in 2022, was estimated to be $2,905.7 million US dollars (US$-PPP 10,324.2 million). The direct medical cost constituted the majority of the economic burden (64.7%), while the inability to work due to these health conditions also contributes significantly (28.6%). Absenteeism (2.9%), presenteeism (1.7%), and premature mortality (2.2%) make up smaller proportions of the overall economic impact of T2D and its complications in Iran during that year.

CONCLUSION

Our study highlights the significant and diverse economic impact of T2D and its complications in Iran. This burden encompasses not only healthcare-related expenses but also negative impacts on society and productivity, as well as the occurrence of early death. To successfully address this burden, a comprehensive strategy is needed, which includes programs to prevent diabetes, better access to healthcare services, and increased social support for individuals with this long-term condition.

Road toward institutionalizing health technology assessment in the Emirate of Abu Dhabi: The role of evidence-informed deliberative processes

OBJECTIVE

This paper reports on the process used to embark on one of the core strategies of Abu Dhabi's Department of Health, which was to develop a roadmap for HTA implementation and institutionalization, based on the aspirations and needs of local stakeholders and making use of the evidence-informed deliberative processes framework. The paper also highlights the main features of the road map that may be expected to address some of the current challenges.

METHODS

A series of activities were undertaken that informed the subsequent development of the roadmap. They comprised a situation analysis using a combination of desk research and semistructured (group) interviews with 45 stakeholders. The findings were discussed in two workshops; face-to-face with nonindustry stakeholders from Abu Dhabi, and online with industry representatives.

RESULTS

Guided by the EDP framework, the roadmap provides instructions how to organize stakeholder involvement, how to identify and operationalize decision criteria, and how to ensure that the decision-making process is transparent. Specific guidance is given on establishing an HTA structure with an appropriate policy framework, the formulation of an HTA program, a communication strategy, as well as building and leveraging HTA expertise.

CONCLUSION

Broad stakeholder consultation has been instrumental toward the establishment of a comprehensive HTA framework in Abu Dhabi, and the development of a road map. The interest raised during stakeholder consultations and the commitments made hold promise for the adoption and establishment of EDP principles to support HTA in Abu Dhabi that have potential to contribute to a sustainable high-quality healthcare system.

The need for implementing a standardized, evidence-based emergency department discharge plan for optimizing adult asthma patient outcomes in the UAE, expert meeting report

BACKGROUND

Asthma is a common chronic respiratory inflammatory disease that adversely affects patients' quality of life (QoL) and overall well-being. When asthma is not adequately controlled, there is a higher risk of exacerbations and hospitalizations, thereby increasing the direct and indirect costs associated with the treatment and productivity loss. Overreliance on SABA and underutilization of ICS in the management of asthma can result in suboptimal treatment and poor asthma control. Patients who visit the emergency department are more likely to have poorly controlled asthma. Ensuring that these patients are provided with an evidence-based treatment plan during discharge can help reduce the risk of future exacerbations and consequently reduce the burden on the UAE healthcare system.

METHODS

A joint task force comprising experts from the Emirates Society of Emergency Medicine (ESEM) and Emirates Thoracic Society (ETS) reviewed published evidence and updated guidelines in asthma management to optimize the post-discharge recommendations.

RESULTS

The ESEM-ETS experts' joint task force has developed a step-by-step plan for emergency department/hospital discharge, which is based on the GINA 2023 guideline recommendations and the medications available in the UAE. By adhering to this structured plan, emergency department physicians can play a crucial role in improving asthma care, long-term patient outcomes, and the utilization of healthcare resources.

CONCLUSIONS

Prioritizing patient education and ensuring patients are equipped with the best-suited asthma treatment plans prior to discharge can help ED physicians improve patient outcomes and reduce healthcare resource utilization in UAE hospitals.

The impact of myasthenia gravis severity on work and daily activities

INTRODUCTION/AIMS

People with myasthenia gravis (MG) experience impaired quality of life. However, the impact of MG symptoms on work productivity has not been well-studied. We aimed to evaluate this impact and to examine associations between disease severity and the degree of impairment.

METHODS

Data were drawn from the Adelphi MG Disease-Specific Programme™, a multinational (USA, France, Germany, Italy, Spain, UK) survey completed by physicians and their patients with MG in 2020. Patient-reported measures included the Work Productivity and Activity Impairment (WPAI): Specific Health Problem questionnaire.

RESULTS

The WPAI questionnaire was completed by 330 patients. Among those currently employed, the mean percentage of work time missed (absenteeism) was 13.3% (N = 116), percentage impairment of productivity at work (presenteeism) was 26.7% (N = 121), and overall work impairment was 30.0% (N = 110). Across all patients, impairment of non-work-related activities due to health problems (ADL impairment) was 39.2% (N = 330). Regression analysis indicated that impairment differed according to MG Foundation of America (MGFA) class (p = .0147, p < .0001, p < .0001 and p < .0001 for absenteeism, presenteeism, overall work impairment and ADL impairment, respectively). Being MGFA class III/IV was a predictor of presenteeism, overall work impairment and ADL impairment in a predictor model.

DISCUSSION

Patients with MG experience substantial work impairment particularly those with more severe symptoms, highlighting an important way in which patient quality of life is negatively affected. More effective treatment strategies would enable patients to lead more productive lives and could impact decisions relating to work and career.

Breast Cancer in the Arabian Gulf Countries

Breast cancer stands as the prevailing malignancy across all six Gulf Cooperation Council (GCC) nations. In this literature review, we highlighted the incidence and trend of breast cancer in the GCC. Most of the studies reported a consistent increase in breast cancer incidence over the past decades, which was particularly attributed to the adoption of a Westernized lifestyle in the region and the implications of emerging risk factors and other environmental and societal factors, the increase in screening uptake, as well as the improvement in data collection and reporting in the GCC. The data on breast cancer risk factors in the GCC were limited. In this geographic region, breast cancer frequently manifests with distinctive characteristics, including an early onset, typically occurring before the age of 50; an advanced stage at presentation; and a higher pathological grade. Additionally, it often exhibits more aggressive features such as human epidermal growth factor receptor 2 (HER2) positivity or the presence of triple-negative (TN) attributes, particularly among younger patients. Despite the growing body of literature on breast cancer in the GCC, data pertaining to survival rates are, regrettably, meager. Reports on breast cancer survival rates emanating from the GCC region are largely confined to Saudi Arabia and the United Arab Emirates (UAE). In the UAE, predictive modeling reveals 2-year and 5-year survival rates of 97% and 89%, respectively, for the same period under scrutiny. These rates, when compared to Western counterparts such as Australia (89.5%) and Canada (88.2%), fall within the expected range. Conversely, Saudi Arabia reports a notably lower 5-year survival rate, standing at 72%. This disparity in survival rates underscores the need for further research directed toward elucidating risk factors and barriers that hinder early detection and screening. Additionally, there is a pressing need for expanded data reporting on survival outcomes within the GCC. In sum, a more comprehensive and nuanced understanding of breast cancer dynamics in this region is imperative to inform effective strategies for prevention, early detection, and improved patient outcomes.

Comparative Performance Evaluation of the Public Health Surveillance System in Six Gulf Cooperation Countries: A Cross-Sectional Study (Preprint)

BACKGROUND

Evaluating public health surveillance systems is important to ensure that events of public health importance are appropriately monitored. Evaluation studies based on the Centers for Disease Control and Prevention (CDC) guidelines have been used to appraise surveillance systems globally. Previous evaluation studies undertaken in member countries of the Gulf Cooperation Council (GCC) were limited to specific illnesses within a single nation.

OBJECTIVE

We aimed to evaluate public health surveillance systems in GCC countries using CDC guidelines and recommend necessary improvements to enhance these systems.

METHODS

The CDC guidelines were used for evaluating the surveillance systems in GCC countries. A total of 6 representatives from GCC countries were asked to rate 43 indicators across the systems' level of usefulness, simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, data quality, stability, and timeliness. Descriptive data analysis and univariate linear regression analysis were performed.

RESULTS

All surveillance systems in the GCC covered communicable diseases, and approximately two-thirds (4/6, 67%, 95% CI 29.9%-90.3%) of them covered health care-associated infections. The mean global score was 147 (SD 13.27). The United Arab Emirates scored the highest in the global score with a rating of 167 (83.5%, 95% CI 77.7%-88.0%), and Oman obtained the highest scores for usefulness, simplicity, and flexibility. Strong correlations were observed between the global score and the level of usefulness, flexibility, acceptability, representativeness, and timeliness, and a negative correlation was observed between stability and timeliness score. Disease coverage was the most substantial predictor of the GCC surveillance global score.

CONCLUSIONS

GCC surveillance systems are performing optimally and have shown beneficial outcomes. GCC countries must use the lessons learned from the success of the systems of the United Arab Emirates and Oman. To maintain GCC surveillance systems so that they are viable and adaptable to future potential health risks, measures including centralized information exchange, deployment of emerging technologies, and system architecture reform are necessary.

The case for investing in the prevention and control of non-communicable diseases in the six countries of the Gulf Cooperation Council: an economic evaluation

Background

While the non-communicable disease (NCD) burden in the countries of the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) has surged over the past decades, the costs and return on investment (ROI) of implementing cost-effective, WHO-recommended NCD interventions have not been established.

Methods

We performed an economic analysis to estimate the ROI from scaling up four sets of NCD interventions over 15 years. We estimated the direct costs of the four main NCDs (cancer, diabetes, cardiovascular diseases and chronic respiratory diseases) using a prevalence-based, bottom-up cost-of-illness approach. We estimated indirect costs based on productivity loss due to absenteeism, presenteeism and premature deaths. We costed the scaling up of interventions using the WHO Costing Tool and assessed the health impact of interventions using the OneHealth Tool. We calculated ROI by comparing productivity and social benefits with the total costs of implementing the interventions.

Results

The four main NCDs cost the GCC economy nearly US$50 billion in 2019, equal to 3.3% of its gross domestic product. The indirect costs are estimated at US$20 billion or 40% of the total burden. Implementing the four modelled intervention packages in the six GCC countries over 15 years will cost US$14 billion, with an ROI of US$4.9 for every US$1 invested and significant health and social benefits, including 290 000 averted premature deaths.

Conclusion

Based on the results of these six investment cases, we recommend actions to scale up current WHO-recommended cost-effective interventions, strengthen whole-of-government action, drive the NCD legislative agenda, build out the evidence base, generate additional advocacy material, and increase regional collaboration and data-sharing to establish best practices and monitor impact.

The economic burden of overweight and obesity in Saudi Arabia

CONTEXT

The prevalence of overweight and obesity in Saudi Arabia has been rising. Although the health burden of excess weight is well established, little is known about the economic burden.

AIMS

To assess the economic burden-both direct medical costs and the value of absenteeism and presenteeism-resulting from overweight and obesity in Saudi Arabia.

SETTINGS AND DESIGN

The cost of overweight and obesity in Saudi Arabia was estimated from a societal perspective using an epidemiologic approach.

METHODS AND MATERIALS

Data were obtained from previously published studies and secondary databases.

STATISTICAL ANALYSIS USED

Overweight/obesity-attributable costs were calculated for six major noncommunicable diseases; sensitivity analyses were conducted for key model parameters.

RESULTS

The impact of overweight and obesity for these diseases is found to directly cost a total of $3.8 billion, equal to 4.3 percent of total health expenditures in Saudi Arabia in 2019. Estimated overweight and obesity-attributable absenteeism and presenteeism costs a total of $15.5 billion, equal to 0.9 percent of GDP in 2019.

CONCLUSIONS

Even when limited to six diseases and a subset of total indirect costs, results indicate that overweight and obesity are a significant economic burden in Saudi Arabia. Future studies should identify strategies to reduce the health and economic burden resulting from excess weight in Saudi Arabia.

Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar

Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r² = 0.949, p = 0.00001) and between the overall cost and procedure cost (r² = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.