Exploring cost drivers for improving disease management: the case of type 2 diabetes at a tertiary hospital in Burundi, Africa

Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco using the interrupted time-series analysis. The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2= -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). The effect of thecovid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

A Literature Review of Health Economic Evaluation: A Case of Vaccination on systematic review analysis.

Background: This study tries to provide a comparative analysis of the systematic review of economic evaluation literature available about vaccines. Methods: PubMed database were searched by using the following keywords: “vaccination/economics [MeSH]”. All articles were included if: 1) A literature or systematic review of vaccination studies; 2) primary or secondary data; 3) published in English; 4) related to human. Exclusion criteria were as followings: 1) editorial, review or methodological articles; 2) not in health sector; 3) not applied from 2009 to 2013. Results: From 22 records found, eleven articles met selection criteria. Only 27.3 percent (3 of 11 studies) was recorded about the methodology of conducting systematic review studies based on the PRISMA, and AMSTAR guideline. Two of eleven studies (18.1 percent) in this review, the authors evaluated the quality of vaccination systematic review studies with different levels including “Moderate” to “Moderate to good” and “Moderate to good”. Discussion and conclusion: According to this study, it helps to understand the current situation for conducting and reporting the economic evaluation of vaccination systematic review studies. Currently, the large number of studies and systematic reviews on the effects of vaccination, high quality evidence to inform policy decisions on how best to use vaccination in health care is still lacking.

Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa.

The aim of this study was to estimate the economic burden of typhoid fever in Pemba, Zanzibar, East Africa. This study was an incidence-based cost-of-illness analysis from a societal perspective. It covered new episodes of blood culture-confirmed typhoid fever in patients presenting at the outpatient or inpatient departments of three district hospitals between May 2010 and December 2010. Cost of illness was the sum of direct costs and costs for productivity loss. Direct costs covered treatment, travel, and meals. Productivity costs were loss of income by patients and caregivers. The analysis included 17 episodes. The mean age of the patients, was 23 years (range=5-65, median=22). Thirty-five percent were inpatients, with a mean of 4.75 days of hospital stay (range=3-7, median=4.50). The mean cost for treatment alone during hospital care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH). The average societal cost was US$ 154.47 per typhoid episode. The major expenditure was productivity cost due to lost wages of US$ 128.02 (83%). Our results contribute to the further economic evaluation of typhoid fever vaccination in Zanzibar and other sub-Saharan African countries.

Treatment Costs of Pneumonia, Meningitis, Sepsis, and Other Diseases among Hospitalized Children in Viet Nam.

The aim of this study was to estimate the costs of treatment of children who present with the signs and symptoms of invasive bacterial diseases in Khanh Hoa province, Viet Nam. The study was an incidencebased cost-of-illness analysis from the health system perspective. The hospital costs included labour, materials and capital costs, both direct and indirect. Costs were determined for 980 children, with an average age of 12.67 months (standard deviation±11.38), who were enrolled in a prospective surveillance at the Khanh Hoa General Hospital during 2005-2006. Of them, 57% were male. By disease-category, 80% were suspected of having pneumonia, 8% meningitis, 3% very severe disease consistent with pneumococcal sepsis, and 9% other diseases. Treatment costs for suspected pneumonia, meningitis, very severe disease, and other diseases were US$ 31, US$ 57, US$ 73, and US$ 24 respectively. Costs ranged from US$ 24 to US$ 164 across different case-categories. Both type of disease and age of patient had statistically significant effects on treatment costs. The results showed that treatment costs for bacterial diseases in children were considerable and might differ by as much as seven times among invasive pneumococcal diseases. Changes in costs were sensitive to both age of patient and case-category. These cost-of-illness data will be an important component in the overall evidence base to guide the development of vaccine policy in Viet Nam.

Treatment Cost for Typhoid Fever at Two Hospitals in Kolkata, India.

The purpose of this study was to estimate treatment cost for typhoid fever at two hospitals in Kolkata, India. This study was an incidence-based cost-of-illness analysis from the providers’ perspective. Microcosting approach was employed for calculating patient-specific data. Unit costs of medical services used in the calculation were directly measured from the study hospital by standard method. The study hospitals were selected based on accessibility to data and cooperation. Eighty-three Widal-positive and/or cultureconfirmed patients with typhoid fever during November 2003–April 2006 were included in the study. Most (93%) patients were children. Eighty-one percent was treated at the outpatient department. The average duration of hospitalization for child and adult patients was 8.4 and 4.2 days respectively. The average cost of treating children, adults, and all patients was US$ 16.72, 72.71, and 20.77 respectively (in 2004 prices). Recalculation based on 80% occupancy rate in inpatient wards (following the recommendation of the World Health Organization) found that the cost of treating children, adults, and all patients was US$ 14.53, 36.44, and 16.11 respectively.

Predicting treatment cost for bacterial diarrhoea at a regional hospital in Thailand.

The aim of this study was to estimate the treatment cost and formulate a cost-function for bacterial diarrhoea among patients in a Thai regional hospital. This study was an incidence-based cost-of-illness analysis from a hospital perspective, employing a micro-costing approach. It covered new episodes of both outpatients and inpatients who were diagnosed to have bacterial diarrhoea (ICD-10 code A00-A05) and who received treatment during 1 October 2000-31 July 2003. Retrospective data were collected from medical records of the hospital. The study covered 384 episodes, and the mean age of patients was 24 years. The average treatment costs (at 2002 prices; US$1 = approximately 40 Thai baht) were US$11.29, 76.78, and 44.72 per outpatient episode, inpatient episode, and outpatient/inpatient combined episode respectively. Furthermore, the positive significant predictor variables were: inpatient care, other Salmonella-associated infections, shigellosis, other bacterial intestinal infections, and the health insurance scheme. The fitted model was able to predict greater than 80% of the treatment cost. The estimation of simulated patients demonstrated a wide range of costs, from US$10 per episode to US$163 per episode. Overall, hospital administrators can apply these results in cost-containment interventions.

Economic burden of road traffic injuries: a micro-costing approach.

This study aimed to determine the economic burden incurred from road traffic injuries in Thailand. It was designed as a prevalence-based cost-of-illness analysis from a societal perspective, employing a micro-costing bottom-up approach. It covered direct medical cost, direct non-medical cost, and indirect cost or productivity loss. Productivity loss covers the costs of work absence or death due to road traffic injuries suffered by persons of working age. We collected data on road traffic injuries and resource utilization which occurred in the fiscal year 2004. A simple random sampling was used to select 200 patients for analysis. The average cost of road traffic injuries per patient was USD 2,596 at 2004 prices. This can be divided into direct cost (USD 102, or 4%) and indirect cost (USD 2,494, or 96%). From these results, we can see that the indirect cost far outweighed the direct cost. To base decisions regarding road safety campaigns on savings of direct costs, particularly direct medical costs, is inadequate. Therefore, data on the complete cost of illness should be taken into account in the planning and creation of a road safety policy.

Measurement of costs.

Costing plays an important role in health economics, particularly economic evaluation. However, there are some controversial issues: concepts, methods and reference values. Hence, it is pivotal to standardize can be con costing methods and use these as national guidelines to produce comparable studies. This report is divided perspectives. into 3 parts: theoretical issues, international guidelines comparison, and recommendations for the Thai technology assessment guidelines. Each section is composed of three general costing steps: identification, appropriate, measuring and valuation. It is recommended to measure economic or opportunity cost mainly in societal perspective. Cost category is composed of direct medical, direct non-medical and indirect costs. The level of reliability of each kind of costing source data is provided. Valuation of resource use based on national government, standard cost menu is recommended for national policy making. The recommendations on cost measurement are appropriate for the Thai context and in the current situation.

Clinical trial of aloe vera linn. for treatment of minor burns.

A randomized controlled trail to assess the efficacy of Aloe vera Linn. for the topical treatment of minor burns was conducted in 38 patients admitted to two community hospitals. Twenty patients were treated with fresh mucilage prepared from Aloe vera Linn. and 18 were treated with silfadiazine. The baseline characteristics of the patients in both groups were not significantly different. The success rates were observed in 95 and 83 percent of the patients in the Aloe vera Linn. group and the silver sulfadiazine group, respectively. About one third of the patients in both groups experienced irritation at the sites of topical treatment