ABSTRACT
Contexte et objectifs. Les hépatites virales chroniques constituent un problème de santé publique en Côte-d'Ivoire. Très peu de malades accèdent au traitement en raison des coûts élevés du bilan et du traitement. L'objectif de la présente étude était d'évaluer les coûts du bilan et du traitement des hépatites virales chroniques. Méthodes. Il s'agissait d'une étude observationnelle transversale analytique réalisée, du 1er mars 2019 au 31 juillet 2019, en consultation d'hépato-gastroentérologie du CHU de Yopougon. Les variables étudiées étaient les paramètres sociodémographiques et économiques. Résultats. Au total, 136 patients (hommes 53, 6 %, âge moyen de 42 ans ± 12,2) ont été inclus. Plus de la moitié des patients (63,3 %) avaient un revenu mensuel n'excédant pas 490.39 USD. Le coût du bilan initial était de 223.13 USD et de 351.14 USD respectivement, pour l'hépatite virale B et C. Le ténofovir et l'interféron pégylé étaient gratuits. Le traitement par sofosbuvir + velpastavir coûtait 593.37 USD. Le bilan de suivi annuel était estimé à 237.02 USD pour l'hépatite virale B, 225.58 USD pour l'hépatite virale C. Conclusion. Le bilan et le traitement des hépatites virales chroniques ont un coût prohibitif pour les patients malgré la couverture maladie universelle.
Context and objectives. Chronic viral hepatitis is a public health problem in Côte-d'Ivoire. A significant number of patients have little access to treatment due to the high costs of assessment and treatment. The objective of our study was to evaluate the costs of assessments and treatment of chronic viral hepatitis. Methods. This was an analytical cross-sectional observational study from March 1, 2019 to July 31, 2019 in the HepatoGastroenterology Consultation Service at the Yopougon University Hospital. The variables studied were socio-demographic and economic parameters. Results. 136 patients (men 53.6 %, average age 42 ± 12.2 years) were included. More than half of the patients (63.3 %) had a monthly income not exceeding 490.39 USD. The cost of the initial assessment was 223.13 USD and 351.14 USD for viral hepatitis B and C, respectively. Tenofovir and pegylated interferon were free of charge. Treatment with sofosbuvir + velpastavir cost 593.37 USD. The annual follow-up assessment was estimated at 237.02 USD for viral hepatitis B and 225.58 USD for viral hepatitis C. Conclusion. The assessment and treatment of chronic viral hepatitis have a cost that remains high for patients despite the universal health coverage.
Subject(s)
Humans , Male , Female , Health Care Costs , Disease Management , Hepatitis C, Chronic , Diagnosis , Hepatitis B , Hepatitis, Viral, HumanABSTRACT
Background: The in-hospital mortality is a major concern in Africa. The study is aimed at providing the determinants of in-hospital mortality of patients admitted in the gastroenterology and medicine unit (GMU) of the teaching hospital of Yopougon (Abidjan, Ivory Coast). Patients and Methods: A retrospective cohort of 341 patients (males: 53%, mean age: 43 years) admitted in the GMU during 2009 were studied. Socio-demographic, clinical, biological characteristics of patients were retrieved. Survival probability and determinants of in-hospital mortality were respectively determined by the Kaplan Meier curve and Cox model. Results: Among the 341 patients admitted, 79 (23.2%) died in the GMU. The in-hospitalmortality rate was 4.3 (95%IC: 3.3-5.2) death per 100 patients-day. The main diagnoses were HIV/AIDS (15%), cirrhosis (14.4%), hepatocellular carcinoma (13.5%), tuberculosis (12.6%) and gastroenteritis (7.9%). Survival probabilities were higher in patients with Financial support (FS) to face medical fees (log rank test = 10.7, P=.001), with no comorbidities (log rank test= 4.5, P=.03) compared to those without, and when diagnoses were established than unknown (log rank test=11. 5, P=.001). In multivariate analysis, prothrombin time <65% (aHR=2.6, P=.02), creatinine level (aHR: 1.02, P=.02), HIV/AIDS or tuberculosis (aHR=0.44, P=.01), non malignant digestive diseases (aHR=0.34, P=.01) and FS (aHR=0.45, P<.02) were significantly associated with mortality in GMU. Conclusion: This study demonstrated that patients with HIV/AIDS or tuberculosis, non malignant digestive diseases or FS had a better outcome. However those with impairment of renal and liver functions had a high risk of death in the GMU.