Cost of illness studies on reproductive, maternal, newborn, and child health: a systematic literature review

Challenges and opportunities in addressing social determinants of child health in Cambodia: perspectives and experience of frontline providers in two health districts

OBJECTIVES

Other forces related to socio-economic and cultural factors, besides biomedical and behavioural fields, also influence health but receive little attention in health research. This study aims to illuminate social determinants of health and to identify challenges and opportunities in addressing social determinants of child health (SDCH) in rural Cambodia.

METHODS

This is a qualitative study based on interviews of frontline primary health care providers, health officials, local authorities and community volunteers in two health districts in Cambodia. The data were supplemented by secondary data on different aspects of the districts and Cambodia.

RESULTS

Poverty, lack of basic commodities and adverse social conditions remained problems for population health. While access to health services was considered adequate, households and communities had several major risk exposures. Challenges in addressing SDCH were the high prevalence of social and household adverse conditions, and the lack of training of providers, of information about social services, of effective coordination and of trust in public services. Opportunities were present, including social services being existent albeit poor functioning, the traditional practice of social inquiry, existing frontline providers being open to further information and training, existing subnational coordination bodies at district and provincial levels, and use of evidence in planning and resource allocation.

CONCLUSION

Addressing SDCH requires broad and coordinated efforts of stakeholders from multiple sectors. Among the prerequisites are to leverage the existing structures and mechanisms, training primary health care providers and providing them with adequate information about local resources and available supports. Improving social care services and infrastructures requires strong coordination, planning and adequate resource allocation.

Monetary value of disability-adjusted life years lost from all causes in Mauritius in 2019

Background: The Republic of Mauritius had a total of 422,567 disability-adjusted life years (DALYs) from all causes in 2019. This study aimed to estimate the monetary value of DALYs lost in 2019 from all causes in Mauritius and those projected to be lost in 2030; and to estimate the monetary value of DALYs savings in 2030 if Mauritius were to attain the national targets related to five targets of the United Nations Sustainable Development Goal 3 on good health and well-being. Methods: The human capital approach was used to monetarily value DALYs lost from 157 causes in 2019. The monetary value of DALYs lost in 2019 from each cause was calculated from the product of net gross domestic product (GDP) per capita in Mauritius and the number of DALYs lost from a specific cause. The percentage reductions implied in the SDG3 targets were used to project the monetary values of DALYs expected in 2030. The potential savings equal the monetary value of DALYs lost in 2019 less the monetary value of DALYs expected in 2030. Results:  The DALYs lost in 2019 had a total monetary value of Int$ 9.46 billion and a mean value of Int$ 22,389 per DALY. Of this amount, 84.2% resulted from non-communicable diseases; 8.7% from communicable, maternal, neonatal, and nutritional diseases; and 7.1% from injuries. Full attainment of national targets related to the five SDG3 targets would avert DALYs losses to the value of Int$ 2.4 billion. Conclusions: Diseases and injuries cause a significant annual DALYs loss with substantive monetary value. Fully achieving the five SDG3 targets could save Mauritius nearly 8% of its total GDP in 2019. To achieve such savings, Mauritius needs to strengthen further the national health system, other systems that tackle the social determinants of health, and the national health research system.

Economic burden of maternal morbidity - A systematic review of cost-of-illness studies

Aim

To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes.

Methods

Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors.

Results

Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified.

Conclusion

Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.

Relationship of Breastfeeding Self-Efficacy with Self-Esteem and General Health in Breastfeeding Mothers Referred to Health Centers of Falavarjan City-Iran, 2015

This study aimed to examine the relationship of breastfeeding self-efficacy with self-esteem and general health. This cross-sectional study was conducted on 547 breastfeeding mothers in Falavarjan-Iran. Participants were selected randomly, and questionnaires of socio-demographic characteristics, breastfeeding self-efficacy, self esteem, and the GHQ-28 were completed through interview. The mean score (SD) of breastfeeding self-efficacy was 134.5 (13.3) from the score range of 33-165. The mean score of self-esteem was 5.89 (4.0) from - 10 to + 10 score range, and the mean score of general health was 19.7 (9.13) from the 0-84 score range. Self-esteem, general health and its dimensions showed a significant relationship with breastfeeding self-efficacy. According to the multivariate linear regression, physical symptoms, social dysfunction, age, education, spouse's job, economic status, duration of previous breastfeeding, and receiving breastfeeding education were related to breastfeeding self-efficacy. The results indicated that with an improvement in self-esteem and general health, breastfeeding self-efficacy escalates significantly.

Prescription Patterns and Burden of Pediatric Asthma in Korea

Purpose

This study aimed to estimate the prevalence, prescription pattern and burden of pediatric asthma in Korea by analyzing the National Health Insurance (NHI) claims data.

Methods

We retrospectively analyzed the insurance claim records from the Korean NHI claims database from January 2010 to December 2014. Asthmatic patients were defined as children younger than 18 years, with appropriate 10th Revision of the International Classification of Diseases codes (J45 or J46) and a prescription for 1 or more asthma maintenance medications at the same date. Hospitalization and emergency department visits for asthma were defined as use of short-acting beta₂-agonists during hospital visits among asthmatic patients.

Results

There were 1,172,807 asthmatic children in 2010, which increased steadily to 1,590,228 in 2014 in Korea. The prevalence showed an increasing trend annually for all ages. The mean prevalence by age in those older than 2 years decreased during the study period (from 39.4% in the 2–3 year age group to 2.6% in the 15–18 year age group). In an outpatient prescription, leukotriene receptor antagonists were the most commonly prescribed medication for all ages. Patients older than 6 years for whom inhaled corticosteroids were prescribed comprised less than 15% of asthmatic patients. The total direct medical cost for asthma between 2010 and 2014 ranged from $376 to $483 million. Asthma-related medical cost per person reached its peak in $366 in 2011 and decreased to $275 in 2014.

Conclusions

The prevalence of pediatric asthma increased annually and decreased with age. Individual cost of asthma showed a decreasing trend in Korean children.

Direct healthcare costs associated with device assessed and self-reported physical activity: results from a cross-sectional population-based study

Background

Physical inactivity (PIA) is an important risk factor for many chronic conditions and therefore might increase healthcare utilization and costs. This study aimed to analyze the association of PIA using device assessed and self-reported physical activity (PA) data with direct healthcare costs.

Methods

Cross-sectional data was retrieved from the population based KORA FF4 study (Cooperative Health Research in the Region of Augsburg) that was conducted in southern Germany from 2013 to 2014 (n = 2279). Self-reported PA was assessed with two questions regarding sports related PA in summer and winter and categorized into “high activity”, “moderate activity”, “low activity” and “no activity”. In a subsample (n = 477), PA was assessed with accelerometers and participants were categorized into activity quartiles (“very high”, “high”, “low” and “very low”) according to their mean minutes per day spent in light intensity, or in moderate-vigorous PA (MVPA). Self-reported healthcare utilization was used to estimate direct healthcare costs. We regressed direct healthcare costs on PA using a two-part gamma regression, adjusted for age, sex and socio-demographic variables. Additional models, including and excluding potential additional confounders and effect mediators were used to check the robustness of the results.

Results

Annual direct healthcare costs of individuals who reported no sports PA did not differ from those who reported high sports PA [+€189, 95% CI: -188, 598]. In the subsample with accelerometer data, participants with very low MVPA had significantly higher annual costs than participants with very high MVPA [+€986, 95% CI: 15, 1982].

Conclusion

Device assessed but not self-reported PIA was associated with higher direct healthcare costs. The magnitude and significance of the association depended on the choice of covariates in the regression models. Larger studies with device assessed PA and longitudinal design are needed to be able to better quantify the impact of PIA on direct healthcare costs.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5906-7) contains supplementary material, which is available to authorized users.

The monetary value of human lives lost due to neglected tropical diseases in Africa

BACKGROUND

Neglected tropical diseases (NTDs) are an important cause of death and disability in Africa. This study estimates the monetary value of human lives lost due to NTDs in the continent in 2015.

METHODS

The lost output or human capital approach was used to evaluate the years of life lost due to premature deaths from NTDs among 10 high/upper-middle-income (Group 1), 17 middle-income (Group 2) and 27 low-income (Group 3) countries in Africa. The future losses were discounted to their present values at a 3% discount rate. The model was re-analysed using 5% and 10% discount rates to assess the impact on the estimated total value of human lives lost.

RESULTS

The estimated value of 67 860 human lives lost in 2015 due to NTDs was Int$ 5 112 472 607. Out of that, 14.6% was borne by Group 1, 57.7% by Group 2 and 27.7% by Group 3 countries. The mean value of human life lost per NTD death was Int$ 231 278, Int$ 109 771 and Int$ 37 489 for Group 1, Group 2 and Group 3 countries, respectively. The estimated value of human lives lost in 2015 due to NTDs was equivalent to 0.1% of the cumulative gross domestic product of the 53 continental African countries.

CONCLUSIONS

Even though NTDs are not a major cause of death, they impact negatively on the productivity of those affected throughout their life-course. Thus, the case for investing in NTDs control should also be influenced by the value of NTD morbidity, availability of effective donated medicines, human rights arguments, and need to achieve the NTD-related target 3.3 of the United Nations Sustainable Development Goal 3 (on health) by 2030.

Economic and disease burden of breast cancer associated with suboptimal breastfeeding practices in Mexico

PURPOSE

Exclusive breastfeeding and longer breastfeeding reduce women's breast cancer risk but Mexico has one of the lowest breastfeeding rates worldwide. We estimated the lifetime economic and disease burden of breast cancer in Mexico if 95% of parous women breastfeed each child exclusively for 6 months and continue breastfeeding for over a year.

METHODS

We used a static microsimulation model with a cost-of-illness approach to simulate a cohort of Mexican women. We estimated breast cancer incidence, premature mortality, disability-adjusted life years (DALYs), medical costs, and income losses due to breast cancer and extrapolated the results to 1.116 million Mexican women of age 15 in 2012. Costs were expressed in 2015 US dollars and discounted at a 3% annual rate.

RESULTS

We estimated that 2,186 premature deaths (95% CI 2,123-2,248), 9,936 breast cancer cases (95% CI 9,651-10,220), 45,109 DALYs (95% CI 43,000-47,217), and $245 million USD (95% CI 234-256) in medical costs and income losses owing to breast cancer could be saved over a cohort's lifetime. Medical costs account for 80% of the economic burden; income losses and opportunity costs for caregivers account for 15 and 5%, respectively.

CONCLUSIONS

In Mexico, the burden of breast cancer due to suboptimal breastfeeding in women is high in terms of morbidity, premature mortality, and the economic costs for the health sector and society.

Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand

As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (R_v, the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles R_v often includes or exceeds one (0.18-3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high.

Economic Burden of Obesity: A Systematic Literature Review

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

Economic burden of stroke in a rural South African setting

Background

Stroke is the second leading cause of mortality and leading cause of disability in South Africa yet published data on the economic costs of stroke is lacking particularly in rural settings.

Methods

We estimate the total direct costs of stroke in 2012 from a health system perspective using a prevalence-based, bottom-up costing approach. Direct costs include diagnosis, inpatient and outpatient care. Analysis is based on the Agincourt health and socio-demographic surveillance system, which covers approximately 90,000 people. Published data from the SASPI study, Tintswalo Hospital Stroke register, and national cost databases were used. Sensitivity analysis was carried out to account for the variability in the data used.

Results

The total direct costs of stroke were estimated to be R2.5–R4.2 million (US$283,500–US$485,000) in 2012 or 1.6–3% of the sub-district health expenditure. Of this, 80% was attributed to inpatient costs. Total costs were most sensitive to the underlying incidence rates and to assumptions regarding service utilisation.

Conclusions

Our study provides a snapshot of costs incurred on stroke in rural South Africa. We show that stroke is a disease with high economic costs. Further studies that assess the lifetime costs of stroke are needed to better understand savings accrued from intervening at different stages of the disease.

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We present the first estimates of costs of treating stroke in rural South Africa.

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Stroke imposes a high economic burden in this setting.

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Total direct costs of US$283,500 –US$485,000 represent 1.6-3% of the sub-district health expenditure.

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Cost-of-illness studies for stroke can be conducted using available information sources.

Lifetime costs of perinatal anxiety and depression

BACKGROUND

Anxiety and depression are common among women during pregnancy and the year after birth. The consequences, both for the women themselves and for their children, can be considerable and last for many years. This study focuses on the economic consequences, aiming to estimate the total costs and health-related quality of life losses over the lifetime of mothers and their children.

METHOD

A pathway or decision modelling approach was employed, based on data from previous studies. Systematic and pragmatic literature reviews were conducted to identify evidence of impacts of perinatal anxiety and depression on mothers and their children.

RESULTS

The present value of total lifetime costs of perinatal depression (anxiety) was £75,728 (£34,811) per woman with condition. If prevalence estimates were applied the respective cost of perinatal anxiety and depression combined was about £8500 per woman giving birth; for the United Kingdom, the aggregated costs were £6.6 billion. The majority of the costs related to adverse impacts on children and almost a fifth were borne by the public sector.

LIMITATIONS

The method was exploratory in nature, based on a diverse range of literature and encountered important data gaps.

CONCLUSIONS

Findings suggest the need to allocate more resources to support women with perinatal mental illness. More research is required to understand the type of interventions that can reduce long-term negative effects for both mothers and offspring.

Global economic burden of schizophrenia: a systematic review

BACKGROUND

Schizophrenia is one of the top 25 leading causes of disability worldwide in 2013. Despite its low prevalence, its health, social, and economic burden has been tremendous, not only for patients but also for families, caregivers, and the wider society. The magnitude of disease burden investigated in an economic burden study is an important source to policymakers in decision making. This study aims to systematically identify studies focusing on the economic burden of schizophrenia, describe the methods and data sources used, and summarize the findings of economic burden of schizophrenia.

METHODS

A systematic review was performed for economic burden studies in schizophrenia using four electronic databases (Medline, EMBASE, PsycINFO, and EconLit) from inception to August 31, 2014.

RESULTS

A total of 56 articles were included in this review. More than 80% of the studies were conducted in high-income countries. Most studies had undertaken a retrospective- and prevalence-based study design. The bottom-up approach was commonly employed to determine cost, while human capital method was used for indirect cost estimation. Database and literature were the most commonly used data sources in cost estimation in high-income countries, while chart review and interview were the main data sources in low and middle-income countries. Annual costs for the schizophrenia population in the country ranged from US$94 million to US$102 billion. Indirect costs contributed to 50%-85% of the total costs associated with schizophrenia. The economic burden of schizophrenia was estimated to range from 0.02% to 1.65% of the gross domestic product.

CONCLUSION

The enormous economic burden in schizophrenia is suggestive of the inadequate provision of health care services to these patients. An informed decision is achievable with the increasing recognition among public and policymakers that schizophrenia is burdensome. This results in better resource allocation and the development of policy-oriented research for this highly disabling yet under-recognized mental health disease.

Cost of stroke in low and middle income countries: a systematic review

BACKGROUND

There is limited information available from low and middle-income countries regarding the cost of stroke treatment. Hence, we aimed to review the costs of stroke in low and middle-income countries.

SUMMARY OF REVIEW

The literature search was done using databases: PubMed/Medline, Ovid, EconLit and Google Scholar from 1966 until January 2014 using key words 'economic impact of stroke', 'cost of illness in low and middle income countries' and 'cost of stroke'. With these key words, 10/184 articles were retained for this review. The cost data were converted to 2013 currency values using a web-based tool (CCEMG-EPPI-centre cost converter). Most of the included studies were conducted in Asia. The design of these studies was retrospective and conducted predominantly in multicenter private hospitals. The highest mean direct medical cost of stroke was US$ 8424 in Nigeria. The lowest mean cost of stroke was in Senegal (US$ 416). The average length of hospital stay was longest (20 days) in China. The main predictors of higher costs appeared to be due to differences in length of stay and stroke severity.

CONCLUSION

Costs of stroke are variable because of heterogeneous healthcare systems prevailing in low and middle-income countries. Length of hospital stay and stroke severity appear to be the main predictors of cost. Understanding the costs of stroke in low and middle-income countries is important. However, the evidence remains limited because there is a lack of standardized research. Future research should focus on using a uniform method across low and middle-income countries for estimating the costs of stroke.