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Sultana M, Watts JJ, Alam NH, Faruque ASG, Fuchs GJ, Gyr N, Ali N, Chisti MJ, Ahmed T, Abimanyi-Ochom J, Gold L. Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective. Arch Dis Child 2024:archdischild-2022-325222. [PMID: 38621857 DOI: 10.1136/archdischild-2022-325222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To estimate inpatient care costs of childhood severe pneumonia and its urban-rural cost variation, and to predict cost drivers. DESIGN The study was nested within a cluster randomised trial of childhood severe pneumonia management. Cost per episode of severe pneumonia was estimated from a healthcare provider perspective for children who received care from public inpatient facilities. A bottom-up micro-costing approach was applied and data collected using structured questionnaire and review of the patient record. Multivariate regression analysis determined cost predictors and sensitivity analysis explored robustness of cost parameters. SETTING Eight public inpatient care facilities from two districts of Bangladesh covering urban and rural areas. PATIENTS Children aged 2-59 months with WHO-classified severe pneumonia. RESULTS Data on 1252 enrolled children were analysed; 795 (64%) were male, 787 (63%) were infants and 59% from urban areas. Average length of stay (LoS) was 4.8 days (SD ±2.5) and mean cost per patient was US$48 (95% CI: US$46, US$49). Mean cost per patient was significantly greater for urban tertiary-level facilities compared with rural primary-secondary facilities (mean difference US$43; 95% CI: US$40, US$45). No cost variation was found relative to age, sex, malnutrition or hypoxaemia. Type of facility was the most important cost predictor. LoS and personnel costs were the most sensitive cost parameters. CONCLUSION Healthcare provider cost of childhood severe pneumonia was substantial for urban located public health facilities that provided tertiary-level care. Thus, treatment availability at a lower-level facility at a rural location may help to reduce overall treatment costs.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jennifer J Watts
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Nur H Alam
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - George J Fuchs
- Department of Paediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Nausad Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Jobayer Chisti
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Julie Abimanyi-Ochom
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Yallew WW, Assefa S, Yemane B. Pneumonia among under - five children in Ethiopia: a retrospective analysis from an urban hospital. RESEARCH SQUARE 2023:rs.3.rs-2790057. [PMID: 37090625 PMCID: PMC10120775 DOI: 10.21203/rs.3.rs-2790057/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Pneumonia is the leading cause of death in under-five children in low-income countries. However, the burden of pneumonia in hospital admission is not traced systematically. This study was conducted to determine the proportion of under-five pneumonia admissions among children admitted to a hospital in Addis Ababa, Ethiopia between 2017-2021. Methods A retrospective record of pediatric admissions to the Yekatit 12 referral hospital in Addis Ababa, Ethiopia was assessed for the period 2017- 2021. The date of admission and discharge, length of stay, and outcome at discharge were collected in accordance with the Ethiopian National Classification of Diseases (NCoD). Descriptive statistics were used to assess the proportion of under-five children with pneumonia. Survival analyses using Log rank test and cox regression analysis were done to assess time to recovery (recovering from illness). Multivariable logistic regression was used to assess the influence of selected factors on pneumonia associated hospital admission. Results Between 2017-2021, 2170 children age 1 to 59 months were admitted, 564 (25.99%; 95% confidence interval 24.18% to 27.87%) were diagnosed with pneumonia. Among the sixty children who died during their hospitalization, 15 had been diagnosed with pneumonia. The median time to recover from pneumonia and discharge was 6 days. The odds of pneumonia hospital admission were higher among younger children (4.36 times higher compared to elder children with 95% CI 2.77,6.87)and were increased between the months of September to November. Conclusions Pneumonia accounts for more than a quarter of hospital admissions in under-five children and for a quarter of deaths in this urban cohort. Hospital admission due to pneumonia was higher among older children (36-59 months of age) in the months following the heavy rain months (September to November) as compared to younger children. Our data strongly support increase of vaccination to prevent under 5 pneumonia.
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Memirie ST, Tolla MT, Rumpler E, Sato R, Bolongaita S, Tefera YL, Tesfaye L, Tadesse MZ, Getnet F, Mengistu T, Verguet S. Out-of-pocket expenditures and financial risks associated with treatment of vaccine-preventable diseases in Ethiopia: A cross-sectional costing analysis. PLoS Med 2023; 20:e1004198. [PMID: 36897870 PMCID: PMC10004560 DOI: 10.1371/journal.pmed.1004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Vaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia. METHODS AND FINDINGS We conducted a cross-sectional costing analysis, from the household (patient) perspective, of care-seeking for VPDs in children aged under 5 years for pneumonia, diarrhea, measles, and pertussis, and in children aged under 15 years for meningitis. Data on OOP direct medical and nonmedical expenditures (2021 USD) and household consumption expenditures were collected from 995 households (1 child per household) in 54 health facilities nationwide between May 1 and July 31, 2021. We used descriptive statistics to measure the main outcomes: magnitude of OOP expenditures, along with the associated CHE within households. Drivers of CHE were assessed using a logistic regression model. The mean OOP expenditures per disease episode for outpatient care for diarrhea, pneumonia, pertussis, and measles were $5·6 (95% confidence interval (CI): $4·3, 6·8), $7·8 ($5·3, 10·3), $9·0 ($6·4, 11·6), and $7·4 ($3·0, 11·9), respectively. The mean OOP expenditures were higher for inpatient care, ranging from $40·6 (95% CI: $12·9, 68·3) for severe measles to $101·7 ($88·5, 114·8) for meningitis. Direct medical expenditures, particularly drug and supply expenses, were the major cost drivers. Among those who sought inpatient care (345 households), about 13·3% suffered CHE, at a 10% threshold of annual consumption expenditures. The type of facility visited, receiving inpatient care, and wealth were significant predictors of CHE (p-value < 0·001) while adjusting for area of residence (urban/rural), diagnosis, age of respondent, and household family size. Limitations include inadequate number of measles and pertussis cases. CONCLUSIONS The OOP expenditures induced by VPDs are substantial in Ethiopia and disproportionately impact those with low income and those requiring inpatient care. Expanding equitable access to vaccines cannot be overemphasized, for both health and economic reasons. Such realization requires the government's commitment toward increasing and sustaining vaccine financing in Ethiopia.
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Affiliation(s)
- Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mieraf Taddesse Tolla
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Rumpler
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Latera Tesfaye
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Fentabil Getnet
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Adamu AL, Karia B, Bello MM, Jahun MG, Gambo S, Ojal J, Scott A, Jemutai J, Adetifa IM. The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2021-007080. [PMID: 35101861 PMCID: PMC8804652 DOI: 10.1136/bmjgh-2021-007080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income. METHODS We recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor). RESULTS Of 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14-22) for outpatients and US$272 (US$271-360) for inpatients. Median household cost was US$51 (US$40-69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job. CONCLUSION Provider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.
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Affiliation(s)
- Aishatu Lawal Adamu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Boniface Karia
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Musa M Bello
- Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
- Community Medicine, Bayero University Faculty of Medicine, Kano, Nigeria
| | - Mahmoud G Jahun
- Paediatrics, Bayero University Faculty of Medicine, Kano, Nigeria
- Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Paediatrics, Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - John Ojal
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Scott
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Jemutai
- Health System & Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M Adetifa
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Shrestha S, Chapagain RH, Purakayastha DR, Basnet S, Wadhwa N, Strand TA, Basnet S. Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal. PLoS One 2021; 16:e0260127. [PMID: 34843530 PMCID: PMC8629207 DOI: 10.1371/journal.pone.0260127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/02/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).
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Affiliation(s)
- Suchita Shrestha
- Department of Pediatrics, Institute of Medicine, Child Health Research Project, Tribhuvan University, Kathmandu, Nepal
| | | | - Debjani Ram Purakayastha
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Srijana Basnet
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Nitya Wadhwa
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Tor A. Strand
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Sudha Basnet
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
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Shahrin L, Chisti MJ, Sarmin M, Rahman ASMMH, Shahid ASMSB, Islam MZ, Afroze F, Huq S, Ahmed T. Intravenous Amoxicillin Plus Intravenous Gentamicin for Children with Severe Pneumonia in Bangladesh: An Open-Label, Randomized, Non-Inferiority Controlled Trial. Life (Basel) 2021; 11:1299. [PMID: 34947830 PMCID: PMC8707665 DOI: 10.3390/life11121299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
The World Health Organization (WHO) recommends intravenous (IV) ampicillin and gentamicin as first-line therapy to treat severe pneumonia in children under five years of age. Ampicillin needs to be administered at a six-hourly interval, which requires frequent nursing intervention and bed occupancy for 5-7 days, limiting its utility in resource-poor settings. We compared the efficacy of IV amoxicillin over IV ampicillin, which is a potential alternative drug in treating severe pneumonia in children between 2-59 months. We conducted an unblinded, randomized, controlled, non-inferiority trial in the Dhaka hospital of icddr,b from 1 January 2018 to 31 October 2019. Children from 2-59 months of age presenting with WHO defined severe pneumonia with respiratory danger signs were randomly assigned 1:1 to either 50 mg/kg ampicillin or 40 mg/kg amoxicillin per day with 7.5 mg/kg gentamicin. The primary outcome was treatment failure as per the standard definition of persistence of danger sign(s) of severe pneumonia beyond 48 h or deterioration within 24 h of therapy initiation. The secondary outcomes were: (i) time required for resolution of danger signs since enrolment, (ii) length of hospital stay, (iii) death during hospitalization, and (iv) rate of nosocomial infections. Among 308 enrolled participants, baseline characteristics were similar among the two groups. Sixty-two (20%) children ended up with treatment failure, 21 (14%) in amoxicillin, and 41 (27%) in ampicillin arm, which is statistically significant (relative risk [RR] 0.51, 95% CI 0.32-0.82; p = 0.004). We reported 14 deaths for serious adverse events, 4 (3%) and 10 (6%) among amoxicillin and ampicillin arm, respectively. IV amoxicillin and IV gentamicin combination is not inferior to combined IV ampicillin and IV gentamicin in treating severe pneumonia in under-five children in Bangladesh. Considering the less frequent dosing and more compliance, IV amoxicillin is a better choice for treating children with severe pneumonia in resource-limited settings.
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Affiliation(s)
- Lubaba Shahrin
- Head Acute Respiratory Infection Unit, Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh
| | - Mohammod Jobayer Chisti
- Head Clinical Research Unit, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh;
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Abu Sayem Mirza Md. Hasibur Rahman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Md. Zahidul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Sayeeda Huq
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh;
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Tirore LL, Abame DE, Sedoro T, Ermias D, Arega A, Tadesse T, Nadamo SA. Time to Recovery from Severe Pneumonia and Its Predictors Among Children 2-59 Months of Age Admitted to Pediatric Ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: Retrospective Cohort Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:347-357. [PMID: 34321951 PMCID: PMC8312316 DOI: 10.2147/phmt.s321184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Background Severe pneumonia is still the greatest infectious cause of morbidity and mortality in children under the age of five around the world. Each night spent in the hospital raises the chance of bad drug responses, infections, and ulcers by 0.5%, 1.6%, and 0.5%, respectively. In Southern Ethiopia, as well as the research area, little is known regarding death and recovery time from severe pneumonia and their determinants. Objective To determine time to recovery from severe pneumonia and its predictors among children 2–59 months of age admitted to pediatric ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital. Methods A facility-based retrospective cohort study was conducted among children 2–59 months of age. Three years’ medical records, from January 2017 to December 2020, were reviewed. A total of 280 children with severe pneumonia were included. In the case of survival time, median was calculated. Kaplan Meier survival curve was used to estimate recovery time from severe pneumonia, and the independent effects of covariates on recovery time were analyzed using multivariable Cox-proportional hazard model. Results The median time to recovery was 4 days (interquartile range = 3, 5). The incidence rate of recovery was 24.16 per 100 person-days. Underweight (adjusted hazard ratio = 0.56, 95% CI = 0.38–0.80), age group 12–35 months (adjusted hazard ratio= 2.0, 95% CI=1.30–3.30), treatment with ampicillin and gentamicin (adjusted hazard ratio= 0.35, 95% CI: 0.13–0.80), and antibiotic change (adjusted hazard ratio= 0.34, 95% CI = 0.21–0.53) were statistically significant predictors of time to recovery from severe pneumonia. Conclusion The median length of stay in the hospital was short (4 days [interquartile range =3, 5]). Time to recover from severe pneumonia was significantly influenced by being underweight, age, antibiotics administered first, and antibiotic change. Measures such as providing nutritious meals to children and ensuring that underweight children are properly managed should be bolstered.
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Affiliation(s)
- Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Desta Erkalo Abame
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tagesse Sedoro
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Dejene Ermias
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abinet Arega
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tegegn Tadesse
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Selamu Abose Nadamo
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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Sultana M, Alam NH, Ali N, Faruque ASG, Fuchs GJ, Gyr N, Chisti MJ, Ahmed T, Gold L. Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study. Arch Dis Child 2021; 106:539-546. [PMID: 33906852 PMCID: PMC8142430 DOI: 10.1136/archdischild-2020-320834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh. DESIGN An incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective. Face-to-face interviews collected data on socioeconomic, resource use and cost from caregivers. A micro-costing bottom-up approach was applied to calculate medical, non-medical and time costs. Multiple regression analysis was applied to explore the factors associated with COI. Sensitivity analysis explored the robustness of cost parameters. SETTING Four urban and rural study sites from two districts in Bangladesh. PATIENTS Children aged 2-59 months with severe pneumonia. RESULTS 1472 children with severe pneumonia were enrolled between November 2015 and March 2019. The mean age of children was 12 months (SD ±10.2) and 64% were male. The mean household cost per episode was US$147 (95% CI 141.1 to 152.7). Indirect costs were the main cost drivers (65%, US$96). Household costs for the poorest income quintile were lower in absolute terms, but formed a higher proportion of monthly income. COI was significantly higher if treatment was received from urban health facilities compared with rural health facilities (difference US$84.9, 95% CI 73.3 to 96.3). Child age, household income, healthcare facility and hospital length of stay (LoS) were significant predictors of household COI. Costs were most sensitive to hospital LoS and productivity loss. CONCLUSIONS Severe pneumonia in young children is associated with high household economic burden and cost varies significantly across socioeconomic parameters. Management strategies with improved accessibility are needed particularly for the poor to make treatment affordable in order to reduce household economic burden.
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh .,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Nur H Alam
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh,Clinical Sciences Division (CSD), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Nausad Ali
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - George J Fuchs
- Department of Paediatrics, University of Kentucky College of Medicine and Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Md Jobayer Chisti
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Sam IC, Ahmad Jaafar N, Wong LP, Nathan AM, de Bruyne JA, Chan YF. Socioeconomic costs of children <5 years hospitalised with acute respiratory infections in Kuala Lumpur, Malaysia. Vaccine 2021; 39:2983-2988. [PMID: 33931252 DOI: 10.1016/j.vaccine.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute respiratory infections (ARI) are a major cause of morbidity and mortality in Malaysian children < 5 years. Knowledge of associated economic costs is important for policymakers to determine cost-effectiveness of interventions, such as pneumococcal or influenza vaccines, which are underused in Malaysia. METHODS Children < 5 years admitted with ARI to a teaching hospital in Kuala Lumpur were prospectively recruited between July 2013 and July 2015. Medical (with and without government subsidies), non-medical and indirect costs from pre-admission, admission and post-discharge were obtained by interviews with carers and from medical records. Respiratory viruses were diagnosed by immunofluorescence and virus culture. RESULTS 200 patients were recruited, and 74 (37%) had respiratory viruses detected. For each admitted ARI, the median direct out-of-pocket cost (subsidized) was USD 189 (interquartile range, 140-258), representing a median 16.4% (10.4-22.3%) of reported monthly household income. The median total direct cost (unsubsidized) was USD 756 (564-987), meaning that government subsidies covered a median 75.2% (70.2-78.4%) of actual costs. Median direct costs for 50 respiratory syncytial virus (RSV) cases were higher than the 126 virus-negative cases (USD 803 vs 729, p = 0.03). The median societal cost (combining direct and indirect costs) was USD 871 (653-1,183), which is 1.8 times the Malaysian health expenditure per capita in 2014. Costs were higher with younger age, presence of comorbidity, prematurity, and detection of a respiratory virus. CONCLUSION These comprehensive estimated costs of ARI admissions in children < 5 years are high. These costs can be used as a basis for planning treatment and preventive strategies, including cost-effectiveness studies for influenza and, in future, RSV vaccines.
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Affiliation(s)
- I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia.
| | - Nabeela Ahmad Jaafar
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Anna Marie Nathan
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Jessie Anne de Bruyne
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
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10
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de Broucker G, Sim SY, Brenzel L, Gross M, Patenaude B, Constenla DO. Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2020; 38:1071-1094. [PMID: 32748334 PMCID: PMC7578143 DOI: 10.1007/s40273-020-00940-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. OBJECTIVE The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. DATA SOURCES Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies must (1) be peer reviewed, (2) be published in 2000-2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. LIMITATIONS We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1-75% of the household's monthly income or 10-83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a 'real-world' estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, 415 North Washington Street, Suite #530, Baltimore, MD, 21231, USA.
| | - So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna O Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- GlaxoSmithKline Plc, Panama City, Panama
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11
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Sabin LL, Estrella B, Sempértegui F, Farquhar N, Mesic A, Halim N, Lin CY, Rodriguez O, Hamer DH. Household Costs Associated with Hospitalization of Children with Severe Pneumonia in Quito, Ecuador. Am J Trop Med Hyg 2020; 102:731-739. [PMID: 32067631 DOI: 10.4269/ajtmh.19-0721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pneumonia remains a leading cause of morbidity and mortality in young children. The total cost of pneumonia-related hospitalization, including household-level cost, is poorly understood. To better understand this burden in an urban setting in South America, we incorporated a cost study into a trial assessing zinc supplements in treatment of severe pneumonia among children aged 2-59 months at a public hospital in Quito, Ecuador, which provides such treatment at no charge. Data were collected from children's caregivers at hospitalization and discharge on out-of-pocket payments for medical and nonmedical items, and on employment and lost work time. Analyses encompassed three categories: direct medical costs, direct nonmedical costs, and indirect costs, which covered foregone wages (from caregivers' self-reported lost earnings) and opportunity cost of caregivers' lost time (based on the unskilled labor wage in Ecuador). Caregivers of 153 children completed all questionnaires. Overall, 57% of children were aged less than 12 months, and 46% were female. Just over 50% of mothers and fathers had completed middle school. Most reported direct costs, which averaged $33. Most also reported indirect costs, the mean of which was $74. Fifty-seven reported lost earnings (mean = $79); 29 reported lost time (estimated mean cost = $37). Stratified analyses revealed similar costs for children < 12 months and ≥ 12 months, with variations for specific items. Costs for hospital-based treatment of severe pneumonia in young children represent a major burden for households in low- to middle-income settings, even when such treatment is intended to be provided at no cost.
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Affiliation(s)
- Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Bertha Estrella
- Escuela de Medicina, Universidad Central del Ecuador, Quito, Ecuador.,Corporacion Ecuatoriana de Biotecnologia, Quito, Ecuador
| | - Fernando Sempértegui
- Escuela de Medicina, Universidad Central del Ecuador, Quito, Ecuador.,Corporacion Ecuatoriana de Biotecnologia, Quito, Ecuador
| | - Norman Farquhar
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan
| | - Aldina Mesic
- Innovations for Poverty Action Zambia, Lusaka, Zambia
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Chia-Ying Lin
- United States Agency for International Development, Arlington, Virginia
| | | | - Davidson H Hamer
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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12
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Machuki JA, Aduda DSO, Omondi AB, Onono MA. Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya. PLoS One 2019; 14:e0225194. [PMID: 31743375 PMCID: PMC6863537 DOI: 10.1371/journal.pone.0225194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facility-based treatment. Methods and findings Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25 ($ 0.93)) and medicine costs (KSH 126.16 ($ 1.33)), respectively. Conclusion This study demonstrates that the costs incurred for home-based pneumonia management are considerably lower compared to those incurred for facility-based management. Opportunity costs (caregiver time and forgone wages) and the cost of medication were the key cost-drivers in the management of pneumonia at the health facility and at home, respectively. These findings emphasize the need to strengthen and scale community case management to overcome barriers and delays in accessing the correct treatment for pneumonia for sick children under 5 years of age.
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Affiliation(s)
- Joel Amenya Machuki
- Department of Research, Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | - Dickens S. Omondi Aduda
- Department of Public Health and Community Development, University of Kabianga, Kericho, Kenya
| | - Abong’o B. Omondi
- Department of Biomedical Sciences and Technology, The National University of Lesotho, Maseru, Lesotho
- Department of Biology, National University of Lesotho, Lesotho, South Africa
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13
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Sultana M, Sarker AR, Ali N, Akram R, Gold L. Economic evaluation of community acquired pneumonia management strategies: A systematic review of literature. PLoS One 2019; 14:e0224170. [PMID: 31648271 PMCID: PMC6812874 DOI: 10.1371/journal.pone.0224170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia. Methods A systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal. Results Nineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies. Conclusion Economic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems. PROSPERO registration no: CRD42018097174
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raisul Akram
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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14
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Ebrahim AJ, Naik F, Teni FS. Costs incurred by caregivers of under-five inpatients with community-acquired pneumonia at a university hospital in south-western Ethiopia. S Afr J Infect Dis 2019; 34:109. [PMID: 34485450 PMCID: PMC8377825 DOI: 10.4102/sajid.v34i1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/11/2019] [Indexed: 11/01/2022] Open
Abstract
Background Pneumonia is one of the commonest diseases among children in Ethiopia resulting in deaths and hospitalisations. The objective of the current study was to determine the cost incurred by caregivers of under-five children with community-acquired pneumonia admitted to the paediatric ward of Jimma University Specialized Hospital, south-western Ethiopia. Methods An institution-based cross-sectional study was conducted from 01 January to 28 February 2017, through interviews with caregivers. Data on costs incurred before hospital visit, direct medical and non-medical costs, and indirect costs incurred by caregivers of the children were collected. The collected data were analysed using Statistical Package for Social Sciences version 23. Results Among the 120 caregivers in the study, a median total cost of 304.5 Ethiopian birr (13.22 USD) was reported. This was mostly contributed by indirect costs associated with earnings lost by caregivers related to travel and stay at hospital with the children. Factors, including permanent residence, family size, hospital stay, wealth index, education and major occupation, were found to have statistically significant association with the level of cost incurred by caregivers. Conclusion This study identified that a significant level of cost is incurred by caregivers of the children in the hospital, a majority of which was contributed by the lost earnings because of the time spent at the hospital with the children.
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Affiliation(s)
- Awol J Ebrahim
- Department of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Feki Naik
- Department of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fitsum S Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Ashraf H, Alam NH, Sultana M, Jahan SA, Begum N, Farzana S, Chisti MJ, Kamal M, Shamsuzzaman A, Ahmed T, Khan JAM, Fuchs GJ, Duke T, Gyr N. Day clinic vs. hospital care of pneumonia and severe malnutrition in children under five: a randomised trial. Trop Med Int Health 2019; 24:922-931. [PMID: 31046165 DOI: 10.1111/tmi.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the clinical outcomes and costs of managing pneumonia and severe malnutrition in a day clinic (DC) management model (outpatient) vs. hospital care (inpatient). METHODS Randomised clinical trial where children aged 2 months to 5 years with pneumonia and severe malnutrition were randomly allocated to DC or inpatient hospital care. We used block randomisation of variable length from 8 to 20 and produced computer-generated random numbers that were assigned to one of the two interventions. Successful management was defined as resolution of clinical signs of pneumonia and being discharged from the model of care (DC or hospital) without need for referral to a hospital (DC), or referral to another hospital. All the children in both DC and hospital received intramuscular ceftriaxone, daily nutrition support and micronutrients. RESULTS Four hundred and seventy children were randomly assigned to either DC or hospital care. Successful management was achieved for 184 of 235 (78.3%) by DC alone, vs. 201 of 235 (85.5%) by hospital inpatient care [RR (95% CI) = 0.79 (0.65-0.97), P = 0.02]. During 6 months of follow-up, 30/235 (12.8%) in the DC group and 36/235 (15.3%) required readmission to hospital in the hospital care group [RR (95% CI) = 0.89 (0.67-1.18), P = 0.21]. The average overall healthcare and societal cost was 34% lower in DC (US$ 188 ± 11.7) than in hospital (US$ 285 ± 13.6) (P < 0.001), and costs for households were 33% lower. CONCLUSIONS There was a 7% greater probability of successful management of pneumonia and severe malnutrition when inpatient hospital care rather than the outpatient day clinic care was the initial method of care. However, where timely referral mechanisms were in place, 94% of children with pneumonia and severe malnutrition were successfully managed initially in a day clinic, and costs were substantially lower than with hospital admission.
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Affiliation(s)
- Hasan Ashraf
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nur H Alam
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Marufa Sultana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Selina A Jahan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurshad Begum
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Sharmin Farzana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohammod J Chisti
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohiuddin Kamal
- Radda Maternal and Child Health Family Planning Centre, Dhaka, Bangladesh
| | - Abu Shamsuzzaman
- Institute of Child Health and Shishu, Sasthya Foundation Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Jahangir A M Khan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK
| | - George J Fuchs
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Niklaus Gyr
- Faculty of Medicine, University of Basel, Basel, Switzerland
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16
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Megiddo I, Klein E, Laxminarayan R. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic-epidemiological analysis using data from India. BMJ Glob Health 2018; 3:e000636. [PMID: 29765775 PMCID: PMC5950640 DOI: 10.1136/bmjgh-2017-000636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 03/29/2018] [Indexed: 11/03/2022] Open
Abstract
Pneumococcal pneumonia causes an estimated 105 000 child deaths in India annually. The planned introduction of the serotype-based pneumococcal conjugate vaccine (PCV) is expected to avert child deaths, but the high cost of PCV relative to current vaccines provided under the Universal Immunization Programme has been a concern. Cost-effectiveness studies from high-income countries are not readily comparable because of differences in the distribution of prevalent serotypes, population and health systems. We extended IndiaSim, our agent-based simulation model representative of the Indian population and health system, to model the dynamics of Streptococcus pneumoniae. This enabled us to evaluate serotype and overall disease dynamics in the context of the local population and health system, an aspect that is missing in prospective evaluations of the vaccine. We estimate that PCV13 introduction would cost approximately US$240 million and avert US$48.7 million in out-of-pocket expenditures and 34 800 (95% CI 29 600 to 40 800) deaths annually assuming coverage levels and distribution similar to DPT (diphtheria, pertussis and tetanus) vaccination (~77%). Introducing the vaccine protects the population, especially the poorest wealth quintile, from potentially catastrophic expenditure. The net-present value of predicted money-metric value of insurance for 20 years of vaccination is US$160 000 (95% CI US$151 000 to US$168 000) per 100 000 under-fives, and almost half of this protection is for the bottom wealth quintile (US$78 000; 95% CI 70 800 to 84 400). Extending vaccination to 90% coverage averts additional lives and provides additional financial risk protection. Our estimates are sensitive to immunity parameters in our model; however, our assumptions are conservative, and if willingness to pay per years of life lost averted is US$228 or greater, then introducing the vaccine is more cost-effective than our baseline (no vaccination) in more than 95% of simulations.
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Affiliation(s)
- Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK.,Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Eili Klein
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA.,Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ramanan Laxminarayan
- Department of Management Science, University of Strathclyde, Glasgow, UK.,Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
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17
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Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, Sinha A, Madhi SA, Khandaker G, Yin JK, Booy R, Huda TM, Rahman QS, El Arifeen S, Gentile A, Giglio N, Bhuiyan MU, Sturm-Ramirez K, Gessner BD, Nadjib M, Carosone-Link PJ, Simões EA, Child JA, Ahmed I, Bhutta ZA, Soofi SB, Khan RJ, Campbell H, Nair H. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2018; 6:010408. [PMID: 27231544 PMCID: PMC4871066 DOI: 10.7189/jogh.06.010408] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health. METHODS We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non-severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions for the management of pneumonia. The mean (95% confidence interval, CI) and median (interquartile range, IQR) treatment costs were estimated and reported where appropriate. RESULTS We identified 24 published studies eligible for inclusion and supplemented these with data from 10 unpublished studies. The 34 studies included in the cost analysis contained data on more than 95 000 children with pneumonia from both low- and-middle income countries (LMIC) and high-income countries (HIC) covering all 6 WHO regions. The total cost (per episode) for management of severe pneumonia was US$ 4.3 (95% CI 1.5-8.7), US$ 51.7 (95% CI 17.4-91.0) and US$ 242.7 (95% CI 153.6-341.4)-559.4 (95% CI 268.9-886.3) in community, out-patient facilities and different levels of hospital in-patient settings in LMIC. Direct medical cost for severe pneumonia in hospital inpatient settings was estimated to be 26.6%-115.8% of patients' monthly household income in LMIC. The mean direct non-medical cost and indirect cost for severe pneumonia management accounted for 0.5-31% of weekly household income. The mean length of stay (LOS) in hospital for children with severe pneumonia was 5.8 (IQR 5.3-6.4) and 7.7 (IQR 5.5-9.9) days in LMIC and HIC respectively for these children. CONCLUSION This is the most comprehensive review to date of cost data from studies on the management of childhood pneumonia and these data should be helpful for health services planning and priority setting by national programmes and international agencies.
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Affiliation(s)
- Shanshan Zhang
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, PR China
| | - Peter M Sammon
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Isobel King
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; NHS Grampian, UK
| | | | | | - Sheila N Araujo
- Department of Community Health, Federal University of Goias, Brazil; State University of Maranhăo, Brazil
| | - Anushua Sinha
- New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Gulam Khandaker
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Jiehui Kevin Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, NSW, Australia; Sydney School of Public Health, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Tanvir M Huda
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Qazi S Rahman
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Angela Gentile
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | - Norberto Giglio
- Epidemiology Department, Ricardo Gutierrez Children Hospital, University of Buenos Aires, Argentina
| | | | - Katharine Sturm-Ramirez
- Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh; Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mardiati Nadjib
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Phyllis J Carosone-Link
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Eric Af Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver School of Medicine, Denver, CO, USA; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Child
- Pharmacy Department, Children's Hospital Colorado, Aurora, CO, USA
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Department of Paediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rumana J Khan
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India
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Murthy S, John D, Godinho IP, Godinho MA, Guddattu V, Nair NS. A protocol for a systematic review of economic evaluation studies conducted on neonatal systemic infections in South Asia. Syst Rev 2017; 6:252. [PMID: 29233168 PMCID: PMC5727883 DOI: 10.1186/s13643-017-0648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neonatal systemic infections and their consequent impairments give rise to long-lasting health, economic and social effects on the neonate, the family and the nation. Considering the dearth of consolidated economic evidence in this important area, this systematic review aims to critically appraise and consolidate the evidence on economic evaluations of management of neonatal systemic infections in South Asia. METHODS Full and partial economic evaluations, published in English, associated with the management of neonatal systemic infections in South Asia will be included. Any intervention related to management of neonatal systemic infections will be eligible for inclusion. Comparison can include a placebo or alternative standard of care. Interventions without any comparators will also be eligible for inclusion. Outcomes of this review will include measures related to resource use, costs and cost-effectiveness. Electronic searches will be conducted on PubMed, CINAHL, MEDLINE (Ovid), EMBASE, Web of Science, EconLit, the Centre for Reviews and Dissemination Library (CRD) Database, Popline, IndMed, MedKnow, IMSEAR, the Cost Effectiveness Analysis (CEA) Registry and Pediatric Economic Database Evaluation (PEDE). Conference proceedings and grey literature will be searched in addition to performing back referencing of bibliographies of included studies. Two authors will independently screen studies (in title, abstract and full-text stages), extract data and assess risk of bias. A narrative summary and tables will be used to summarize the characteristics and results of included studies. DISCUSSION Neonatal systemic infections can have significant economic repercussions on the families, health care providers and, cumulatively, the nation. Pediatric economic evaluations have focused on the under-five age group, and published consolidated economic evidence for neonates is missing in the developing world context. To the best of our knowledge, this is the first review of economic evidence on neonatal systemic infections in the South Asian context. Further, this protocol provides an underst anding of the methods used to design and evaluate economic evidence for methodological quality, transparency and focus on health equity. This review will also highlight existing gaps in research and identify scope for further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017047275.
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Affiliation(s)
- Shruti Murthy
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Level 6, Health Science Library Building, Madhav Nagar, Manipal, Karnataka, 576104, India.
| | - Denny John
- The Campbell Collaboration, New Delhi, India.,Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Myron Anthony Godinho
- Public Health Evidence South Asia (PHESA), Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vasudeva Guddattu
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Level 6, Health Science Library Building, Madhav Nagar, Manipal, Karnataka, 576104, India
| | - N Sreekumaran Nair
- Department of Biostatistics (Biometrics), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Purakayastha DR, Rai SK, Broor S, Krishnan A. Cost of Treatment of Febrile Acute Respiratory Infection (FARI) Among Under-Five Children Attending Health Facilities of Ballabgarh, Haryana. Indian J Pediatr 2017; 84:902-907. [PMID: 28831731 DOI: 10.1007/s12098-017-2420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the expenditure incurred towards treatment of an episode of respiratory infection among under-fives in outpatient and inpatient departments of primary and secondary level health facilities. METHODS During March 2011 - September 2012, under-five children presenting with febrile acute respiratory infection (FARI) in the outpatient (OPD) and inpatient (IPD) departments of public and private health facilities of Ballabgarh, Haryana were enrolled in the study. Children who were free from co-morbidities and whose contact number or proper address were available, were enrolled and followed up over telephone or by house visits till recovery. Information was collected on expenditure incurred towards treatment of FARI. Work loss of each day was valued as per capita national income per day. Cost of service in public facilities were supplemented by WHO-CHOICE estimates. The cost of respiratory episode in different settings are expressed in median and inter quartile range (IQR). RESULTS One hundred fourteen children from OPD and 75 from IPD were enrolled and followed up till recovery. Among eligible children 40% and 20% in OPD and IPD were excluded respectively as they could not provide address or contact number. The median costs of an episode treated in OPD and IPD were INR 447(IQR: INR 294-669) and INR 7506.06 (IQR: INR 3765-10,406) respectively. CONCLUSIONS Respiratory infections are responsible for substantial economic burden, especially with huge proportion of out-of-pocket expenditure. Total cost of a respiratory episode that required hospitalization was 1.5 times the per capita monthly income of an Indian.
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Affiliation(s)
| | - Sanjay Kumar Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Memirie ST, Metaferia ZS, Norheim OF, Levin CE, Verguet S, Johansson KA. Household expenditures on pneumonia and diarrhoea treatment in Ethiopia: a facility-based study. BMJ Glob Health 2017; 2:e000166. [PMID: 28589003 PMCID: PMC5321393 DOI: 10.1136/bmjgh-2016-000166] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/10/2016] [Accepted: 11/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background Out-of-pocket (OOP) medical payments can lead to catastrophic health expenditure and impoverishment. We quantified household OOP expenditure for treatment of childhood pneumonia and diarrhoea and its impact on poverty for different socioeconomic groups in Ethiopia. Methods This study employs a mix of retrospective and prospective primary household data collection for direct medical and non-medical costs (2013 US$). Data from 345 pneumonia and 341 diarrhoea cases (0–59 months of age) were collected retrospectively through exit interviews from 35 purposively sampled health facilities in Ethiopia. Prospective 2-week follow-up interviews were conducted at the household level using a structured questionnaire. Results The mean total medical expenditures per outpatient visit were US$8 for pneumonia and US$6 for diarrhoea, while the mean for inpatient visits was US$64 for severe pneumonia and US$79 for severe diarrhoea. The mean associated direct non-medical costs (mainly transport costs) were US$2, US$2, US$13 and US$20 respectively. 7% and 6% of the households with a case of severe pneumonia and severe diarrhoea, respectively, were pushed below the extreme poverty threshold of purchasing power parity (PPP) US$1.25 per day. Wealthier and urban households had higher OOP payments, but poorer and rural households were more likely to be impoverished due to medical payments. Conclusions Households in Ethiopia incur considerable costs for the treatment of childhood diarrhoea and pneumonia with catastrophic consequences and impoverishment. The present circumstances call for revisiting the existing health financing strategy for high-priority services that places a substantial burden of payment on households at the point of care.
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Affiliation(s)
| | | | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Carol E Levin
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Usuf E, Mackenzie G, Sambou S, Atherly D, Suraratdecha C. The economic burden of childhood pneumococcal diseases in The Gambia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2016; 14:4. [PMID: 26893592 PMCID: PMC4758012 DOI: 10.1186/s12962-016-0053-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases. Methods We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit. Results A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account. Conclusion The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society. Electronic supplementary material The online version of this article (doi:10.1186/s12962-016-0053-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Effua Usuf
- MRC, The Gambia Unit, PO Box 273, Banjul, Gambia
| | - Grant Mackenzie
- MRC, The Gambia Unit, PO Box 273, Banjul, Gambia ; Pneumococcal Group, Murdoch Children's Research Institute, Parkville, Australia ; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Chutima Suraratdecha
- PATH, Seattle, USA ; U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Sadruddin S, Shehzad S, Bari A, Khan A, Khan A, Qazi S. Household costs for treatment of severe pneumonia in Pakistan. Am J Trop Med Hyg 2015; 87:137-143. [PMID: 23136289 PMCID: PMC3748514 DOI: 10.4269/ajtmh.2012.12-0242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Current World Health Organization (WHO) guidelines for severe pneumonia treatment of under-5 children recommend hospital referral. However, high treatment cost is a major barrier for communities. We compared household costs for referred cases with management by lady health workers (LHWs) using oral antibiotics. This study was nested within a cluster randomized trial in Haripur, Pakistan. Data on direct and indirect costs were collected through interviews and record reviews in the 14 intervention and 14 control clusters. The average household cost/case for a LHW managed case was $1.46 compared with $7.60 for referred cases. When the cost of antibiotics provided by the LHW program was excluded from the estimates, the cost/case came to $0.25 and $7.51 for the community managed and referred cases, respectively, a 30-fold difference. Expanding severe pneumonia treatment with oral amoxicillin to community level could significantly reduce household costs and improve access to the underprivileged population, preventing many child deaths.
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Affiliation(s)
- Salim Sadruddin
- *Address correspondence to Salim Sadruddin, Department of Health and Nutrition, Save the Children, 54 Wilton Street, Westport, CT 06880. E-mail:
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Farooqui H, Jit M, Heymann DL, Zodpey S. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates. PLoS One 2015; 10:e0129191. [PMID: 26086700 PMCID: PMC4472804 DOI: 10.1371/journal.pone.0129191] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/07/2015] [Indexed: 10/27/2022] Open
Abstract
The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of severe pneumonia and 0.35 million (0.31-0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49-0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92-119 thousand) pneumococcal deaths occurred in India. The top contributors to India's pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden.
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Affiliation(s)
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Modelling and Economics Unit, Public Health England
| | - David L. Heymann
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Awasthi S, Nichter M, Verma T, Srivastava NM, Agarwal M, Singh JV. Revisiting community case management of childhood pneumonia: perceptions of caregivers and grass root health providers in Uttar Pradesh and Bihar, northern India. PLoS One 2015; 10:e0123135. [PMID: 25898211 PMCID: PMC4405201 DOI: 10.1371/journal.pone.0123135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India. Objectives To identify predisposing, enabling and service-related factors influencing treatment delay for CAP in rural communities of two states in India. Factors investigated included recognition of danger signs of CAP, health care decision making, self-medication, treatment and referral by local practitioners, and perceptions about quality of care. Methods Qualitative research employing case studies (CS) of care-seeking, key informant interviews (KII), semi-structured interviews (SSI) and focus group discussions (FGD) with both video presentations of CAP signs, and case scenarios. Interviews and FGDs were conducted with parents of under-five children who had suffered CAP, community health workers (CHW), and rural medical practitioners (RMP). Results From September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42 FGDs were conducted. Recognition of danger signs of CAP among caregivers was poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest in-drawing was recognized as a sign of serious illness, but not commonly monitored by removing a child’s clothing. Most cases of mild to moderate CAP were brought to RMP, and more severe cases taken to private clinics in towns. Mothers consulted local RMP directly, but decisions to visit doctors outside the village required consultation with husband or mother-in-law. By the time most cases reached a public tertiary-care hospital, children had been ill for a week and treated by 2-3 providers. Quality of care at government facilities was deemed poor by caregivers. Conclusion To reduce CAP-associated mortality, recognition of its danger signs and the consequences of treatment delay needed to be better recognized by caregivers, and confidence in government facilities increased. The involvement of RMP in community based CAP programs needs to be investigated further given their widespread popularity.
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Affiliation(s)
- Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
- * E-mail:
| | - Mark Nichter
- The School of Anthropology, University of Arizona, Tucson, United States of America
| | - Tuhina Verma
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | | | - Monica Agarwal
- Department of Community Medicine, King George’s Medical University, Lucknow, India
| | - Jai Vir Singh
- Department of Community Medicine, King George’s Medical University, Lucknow, India
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Peasah SK, Purakayastha DR, Koul PA, Dawood FS, Saha S, Amarchand R, Broor S, Rastogi V, Assad R, Kaul KA, Widdowson MA, Lal RB, Krishnan A. The cost of acute respiratory infections in Northern India: a multi-site study. BMC Public Health 2015; 15:330. [PMID: 25880910 PMCID: PMC4392863 DOI: 10.1186/s12889-015-1685-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high mortality and morbidity resulting from acute respiratory infections (ARI) globally, there are few data from low-income countries on costs of ARI to inform public health policy decisions We conducted a prospective survey to assess costs of ARI episodes in selected primary, secondary, and tertiary healthcare facilities in north India where no respiratory pathogen vaccine is routinely recommended. Methods Face-to-face interviews were conducted among a purposive sample of patients with ARI from healthcare facilities. Data were collected on out-of-pocket costs of hospitalization, medical consultations, medications, diagnostics, transportation, lodging, and missed work days. Telephone surveys were conducted two weeks after medical encounters to ask about subsequent missed work and costs incurred. Costs of prescriptions and diagnostics in public facilities were supplemented with WHO-CHOICE estimates of hospital bed costs. Missed work days were assigned cost based on the national annual per capita income (US$1,104). Non-medically attended ARI cases were identified from an ongoing community-based ARI surveillance project in Faridabad. Results During September 2012-March 2013, 1766 patients with ARI were enrolled, including 451 hospitalized patients, 1056 outpatients, and 259 non-medically attended patients. The total direct cost of an ARI episode requiring outpatient care was US$4- $6 for public and $3-$10 for private institutions based on age groups. The total direct cost of an ARI episode requiring hospitalized care was $54-$120 in public and $135-$355 in private institutions. The cost of ARI among those hospitalized was highest among persons aged > = 65 years and lowest among children aged < 5 years. Indirect costs due to missed work days were 16-25% of total costs. The direct out-of-pocket cost of hospitalized ARI was 34% of annual per capita income. Conclusions The cost of hospitalized ARI episodes in India is high relative to median per capita income. Data from this study can inform evaluations of the cost effectiveness of proven ARI prevention strategies such as vaccination. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1685-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel K Peasah
- College of Pharmacy, Mercer University, 3001 Mercer University Drive, Atlanta, GA, 30341-4155, USA. .,Centers for Disease Control and Prevention, Atlanta, USA.
| | - Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, 190011, J&K, India.
| | | | - Siddhartha Saha
- Influenza Division, Centre for disease control and Prevention, US Embassy, Shantipath, Chanakyapuri, New Delhi, 110021, India.
| | - Ritvik Amarchand
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Shobha Broor
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Vaibhab Rastogi
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Romana Assad
- Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, 190011, J&K, India.
| | | | | | - Renu B Lal
- Influenza Division, Centre for disease control and Prevention, US Embassy, Shantipath, Chanakyapuri, New Delhi, 110021, India.
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Le P, Griffiths UK, Anh DD, Franzini L, Chan W, Pham H, Swint JM. The economic burden of pneumonia and meningitis among children less than five years old in Hanoi, Vietnam. Trop Med Int Health 2014; 19:1321-7. [DOI: 10.1111/tmi.12370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Phuc Le
- University of Texas School of Public Health at Houston; Houston TX USA
| | | | - Dang D. Anh
- Vietnam National Institute of Hygiene and Epidemiology; Hanoi Vietnam
| | - Luisa Franzini
- University of Texas School of Public Health at Houston; Houston TX USA
| | - Wenyaw Chan
- University of Texas School of Public Health at Houston; Houston TX USA
| | - Ha Pham
- Vietnam National Hospital of Pediatrics; Hanoi Vietnam
| | - John M. Swint
- University of Texas School of Public Health at Houston; Houston TX USA
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Alvis-Guzman N, Orozco-Africano J, Paternina-Caicedo A, Coronell-Rodríguez W, Alvis-Estrada L, Jervis-Jálabe D, De la Hoz-Restrepo F. Treatment costs of diarrheal disease and all-cause pneumonia among children under-5 years of age in Colombia. Vaccine 2013; 31 Suppl 3:C58-62. [DOI: 10.1016/j.vaccine.2013.05.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 04/29/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
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Griffiths UK, Clark A, Hajjeh R. Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants. J Pediatr 2013; 163:S50-S59.e9. [PMID: 23773595 PMCID: PMC5749634 DOI: 10.1016/j.jpeds.2013.03.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low- and middle-income countries and identify the model variables, which are most important for the result. STUDY DESIGN A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. RESULTS From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%-53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. CONCLUSIONS Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae.
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Affiliation(s)
- Ulla Kou Griffiths
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine London, United Kingdom.
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Clark AD, Griffiths UK, Abbas SS, Rao KD, Privor-Dumm L, Hajjeh R, Johnson H, Sanderson C, Santosham M. Impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccination in India. J Pediatr 2013; 163:S60-72. [PMID: 23773596 PMCID: PMC5748935 DOI: 10.1016/j.jpeds.2013.03.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate the potential health impact and cost-effectiveness of nationwide Haemophilus influenzae type b (Hib) vaccination in India. STUDY DESIGN A decision support model was used, bringing together estimates of demography, epidemiology, Hib vaccine effectiveness, Hib vaccine costs, and health care costs. Scenarios favorable and unfavorable to the vaccine were evaluated. State-level analyses indicate where the vaccine might have the greatest impact and value. RESULTS Between 2012 and 2031, Hib conjugate vaccination is estimated to prevent over 200 000 child deaths (∼1% of deaths in children <5 years of age) in India at an incremental cost of US$127 million per year. From a government perspective, state-level cost-effectiveness ranged from US$192 to US$1033 per discounted disability adjusted life years averted. With the inclusion of household health care costs, cost-effectiveness ranged from US$155-US$939 per discounted disability adjusted life year averted. These values are below the World Health Organization thresholds for cost effectiveness of public health interventions. CONCLUSIONS Hib conjugate vaccination is a cost-effective intervention in all States of India. This conclusion does not alter with plausible changes in key parameters. Although investment in Hib conjugate vaccination would significantly increase the cost of the Universal Immunization Program, about 15% of the incremental cost would be offset by health care cost savings. Efforts should be made to expedite the nationwide introduction of Hib conjugate vaccination in India.
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Affiliation(s)
- Andrew D. Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ulla K. Griffiths
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Rana Hajjeh
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control, Atlanta, GA
| | - Hope Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Colin Sanderson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Luis Roberto RS, Carlos Alberto VV, Patricio Reinaldo VG, Herenia Gutiérrez Ponce. Impacto de Dos Métodos Alternativos de Asignación de Costos Indirectos Estructurales de Hospitales Públicos Chilenos en el Costo Final de Producción de Servicios Sanitarios. Value Health Reg Issues 2012; 1:142-149. [DOI: 10.1016/j.vhri.2012.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sinha A, Kim S, Ginsberg G, Franklin H, Kohberger R, Strutton D, Madhi SA, Griffiths UK, Klugman KP. Economic burden of acute lower respiratory tract infection in South African children. Paediatr Int Child Health 2012; 32:65-73. [PMID: 22595212 DOI: 10.1179/2046905512y.0000000010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRTI) are a leading cause of childhood mortality, but there are few data on disease costs in developing countries. OBJECTIVES This study's purpose was to analyse ALRTI's costs-of-illness and economic burden in urban South African children. METHODS ALRTI costs-of-illness (expressed in US$ 2010) at a tertiary hospital were measured using a micro-costing approach nested within a clinical trial. Demographic, epidemiological and data on use of health resources were integrated with costs-of-illness to estimate the economic burden of ALRTI in urban South African children aged <5 years. RESULTS 745 children experiencing 858 ALRTI episodes were studied. 338 (39.4%), 513 (59.8%) and 7 (0.8%) episodes were managed in short-stay, paediatric ward and intensive care settings, respectively. Mean lengths of stay in short-stay, paediatric ward and intensive care (ICU) were 1.4, 8.1 and 14.4 days, respectively. The societal costs-of-illness per ALRTI episode managed in short-stay and paediatric ward settings, respectively, were US$266 (95% CI 245-286) and 1287 (95% CI 1174-1401) in HIV-infected patients, and US$257 (95% CI 247-267) and 1032 (95% CI 931-1133) in HIV-uninfected patients. Family costs were not collected in ICUs. ICU direct medical costs were US$5968 (95% CI 4025-8056) in HIV-uninfected patients and US$7849 in one HIV-infected patient. Under-5 children experienced an estimated 424,220 episodes annually of ALRTI. ALRTI treatment cost the public health system an estimated US$28,975,000 while an additional US$539,000 of costs were borne by families. CONCLUSION ALRTIs in children <5 years impose a heavy economic burden on families and the South African public health-care system.
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Affiliation(s)
- Anushua Sinha
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Newark, USA.
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Gupta M, Prinja S, Kumar R, Kaur M. Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India. Health Policy Plan 2012; 28:51-61. [DOI: 10.1093/heapol/czs025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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