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El artículo tiene como objetivo analizar la disponibilidad, acceso y asequibilidad de los medicamentos para niños con Enfermedad Renal Crónica (ERC) en tratamiento con hemodiálisis (HD) en un país de bajos a medianos ingresos. Se llevó a cabo un estudio transversal para determinar los medicamentos más utilizados en una unidad de hemodiálisis pediátrica, incluyendo el nombre del medicamento, dosis, frecuencia, forma farmacéutica y vía de administración. Dos farmacias dentro del perímetro del hospital, una pública y una privada, fueron consultadas para determinar el costoy disponibilidad de medicamentos genéricos y de marca. De un total de 30 pacientes de la unidad de hemodiálisis, 22 expedientes fueron revisados. En general 94% de marca se encontraban disponibles en las farmacias consultadas en comparación a un 52% de los medicamentos genéricos. En farmacias públicas, 41% de medicamentos de marca y 29% de medicamentos genéricos se encontraban disponibles. El costo promedio para un mes de tratamiento con medicamentos de marca adquiridos en una farmacia privada era de $495.00 vs $299.00 en una farmacia pública. Para medicamentos genéricos, el costo promedio correspondía a $414.00 y $239.00 en farmacias privadas y públicas respectivamente. En promedio, los medicamentos de marca adquiridos en una farmacia privada requieren 41 días de trabajo en un mes a comparación de 25 días si se adquieren en una farmacia pública. Los medicamentos genéricos adquiridos en farmacias privadas corresponden a 34 días de trabajo vs 20 días en farmacias públicas. En general existió un acceso limitado a medicamentos genéricos y los medicamentos poseen un costo general más elevado a comparación de otros países lo que implica un posible impacto en la adherencia terapéutica y los padecimientos secundarios de la ERC en los pacientes pediátricos en Guatemala. Esta realidad se puede aplicar a otros países de bajos a medianos ingresos.
This article aims to analyze the availability, access, and affordability of medications for children with advanced Chronic Kidney Disease (CKD) treated with hemodialysis (HD) in a low to middle income country (LMIC). A cross- sectional chart review was carried out to determine the most common medications used in an HD pediatric unit, including medication name, dose, frequency, dosage form, and route of administration. Two pharmacies within the hospital perimeter, one public and one private, were consulted to determine medication cost and availability for generic and brand-name equivalents. From 30 patients attending the HD unit, 22 records were reviewed. Overall, 94 % of brand name medications were available at pharmacies consulted, versus and 52% of generic medications. In public pharmacies, 41% of brand name, and 29% of generic medications were available. The average cost for a full month´s treatment for brand name drugs in the private pharmacy was 495.00 USD versus 299.00 USD in the public pharmacy. For generic drugs, the average cost was 414.00 USD, and 239.00 USD in private and public pharmacies respectively. On average, brand-name drugs in the private pharmacy cost 41 days' wages versus 25 in the public pharmacy. Generic drugs in the private pharmacy cost 34 days' wages versus 20 in the public pharmacy. Overall, there was limited access to generic medications, medications had an overall high cost compared to other countries both of which have the potential to impact treatment adherence and overall outcomes of CKD5 pediatric patients in Guatemala. This reality can be translated to other LMIC.
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Background: A lack of availability of suitable pediatric formulation and high price are often the major hindrance to the better access of the essential treatment to the children. In the backdrop of paucity of literature addressing this problem in India and in particular West Bengal, the present work was planned. Aim and Objectives: This study has been a maiden approach to generate data regarding this issue in small scale and in an inexpensive way after conducting a survey in different government and private facilities in a district of West Bengal, India. Materials and Methods: This cross-sectional study used “WHO Children’s Medicines Survey Form” to make a rapid assessment of availability and pricing of 20 core children’s medicine formulations among ten government hospitals and nine private retail pharmacies in the district of Burdwan in West Bengal during September-October 2009. In retail pharmacies, the actual price to the patient of the cheapest brand was documented. In public health facilities, procurement prices for medicines were obtained from state government’s Central Medical Stores (CMS) listing. Results: Overall, the availability was sub-optimal in all levels of public health facilities-30% in medical college pharmacy, 33% in the district reserve stores, 33.75% in sub-divisional hospitals, 32.25% in primary health centers, and in retail pharmacies was only 45%. Out of the 20 formulations, only two (ORS, paracetamol) were available in all the public and private retail pharmacies. Availability of anti-infectives was better than other medicines in both types of facilities. The variation of prices among different brands was wide. The cost of even the cheapest brand was much higher than corresponding government procurement price. Conclusion: This maiden effort reveals sub-optimal availability of core essential medicines for children in both public facilities and private retail pharmacies. However, medicines available in private pharmacies were much costlier compared to CMS procurement price. This is a matter of concern. A larger nation-wide study is the need of the hour with a greater focus on affordability and prescribing behavior.
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OBJECTIVE To boost access to medical insurance for drugs and improve the accessibility and affordability of drugs. METHODS The current status of the application of international and domestic drug Managed Entry Agreement （MEA）were investigated through literature research method and other methods ，and analyzed comparatively from the aspects of the scope of agreement drugs ，the types of agreements and the content of the agreement ，etc. The problems existing in the application of drug MEA in China were summarized to put forward the suggestions. RESULTS & CONCLUSIONS The UK ，Australia and Italy had rich experience in the application of drug MEA ，and the operation management mechanism were complete. The scope of drugs included in MEA in these countries were relatively broad and the types of agreements were relatively diversified. In China ，drugs included in MEA were mainly oncology drugs and rare disease drugs. The types of agreements mainly included “finance-based agreements”and effect guarantee/effect-based payment in individual-level of“performance-based agreements ”. China ’s evidence collection platform was imperfect and lacked standardized process of MEA. It is suggested that stakeholders should consider increasing the types of drugs ，diversified types of agreements ，improving the accuracy and continuity of evidence collection ， establishing a standardized process for MEA.
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OBJECTIVE：To evaluate the price and affordability of rare disease drugs in China and provide the suggestions for the improvement of rare disease drug affordability in order to provide reference for the relevant decision-making of government departments. METHODS ：According to the List of the First Batch of Rare Diseasesand Diagnosis and Treatment Guideline for Rare Diseases（2019 edition），rare disease drugs were selected. The median price ratio （MPR）was used to evaluate the drug price level ， and the ratio of the annual drug costs to the annual disposable income of urban or rural residents was used to evaluate the affordability，and the impact of price management policieson drug prices and affordability. RESULTS and CONCLUSIONS ：A total of 71 kinds of rare disease drugs were included ，and the median MPR of them was 0.83；among them ，the median MPR of the original drugs was 1.13，and the median MPR of the generic drugs was 0.37. The annual cost of 71 rare disease drugs was 0.001-178.43 times the average annual income of urban residents ，and 0.003-456.57 times the average annual income of rural residents. There were 21 and 28 drugs whose annual cost exceeded the annual income of urban and rural residents.After the implementation of national medical insurance negotiation or volume based procurement of 14 drugs，the median MPR of these drugs decreased from 1.71 to 0.46. For urban residents ，the number of unaffordable drugs had been reduced from 8 to 0；for rural residents，it had been reduced from 10 to 5. In summary ，the price level of orphan drugs in China was slightly lower than international reference price ，but the price level of original drugs was higher than the international reference price ，and the cost of some drugs far exceeded the residents ’ability to pay. It is suggested that the government should strengthen the price management of original drugs ，promote the substitution of high-quality generic drugs for original drugs ，and improve the payment system for high-value rare disease drugs.
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Background: In many parts of the world, presentations for most gynecological cancers are late; this makes treatment difficult due to the cost of chemotherapy or radiotherapy which form the bedrock for cure or palliation. Objective of this study was to determine the types, stage at diagnosis, affordability of care and outcome of treatment of gynaecological cancers in Federal Medical Centre Azare, Bauchi State, Nigeria.Methods: All cases of gynaecological cancers seen over a ten-year period, from 1st January, 2003 to 31st December, 2012 were reviewed retrospectively. The number of all gynaecological cases seen during the period was also extracted.Results: Gynaecological cancer cases accounted for 11.84 % of 8,642 gynaecological cases seen during the period of study. The mean age and parity of the women were 42±5 SD years and 5±1 SD respectively. Cervical cancer accounted for 55 %, ovarian cancer 30%, endometrial cancer 6%, choriocarcinoma 5%, secondaries/ cancers of undetermined origin were 4%. Ninety-two percent presented with advanced stage of diseases. Only 25.3% could afford the cost of full treatment, and 8.4% attained cure of their disease. The modalities of treatment available were surgery and chemotherapy.Conclusions: Cervical and Ovarian Cancers remain the leading types of gynaecological cancers in our environment and late presentations are frequent occurrence. Late presentation and unaffordability of treatments are major challenges associated with the management of these patients. Early presentation and funding mechanisms for gynaecological cancers are keys to improved cure rate and reduced mortality.
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OBJECTIVE：To provide reference for improving the equity of medicine in China ，and to provide reference for promoting the full coverage policy for essential medicine. METHODS ：Taking hypertension essential medicines full coverage policy in 4 areas of Taizhou in Zhejiang province as an example ，the electronic health records of patients in baseline year and the first ， second and third years after the implementation of the full coverage policy of hypertension were collected. The catastrophic expenditure of family drugs was used to measure the medicine cost burden ，and the effects of policy on the equity and change of local medicine cost burden were analyz ed by means of concentration index and its decomposition method. RESULTS ：With the increase of the proportion of patients taking free medicine ，the incidence of catastrophic expenditure on household medicines in the high，middle and low income group decreased year by year generally （decreasing from 6.3％，12.0％，16.4％ of baseline year to 4.7％，8.9％，12.4％ at the third year after the implementation of the policy ）；the gap among the three groups was in narrowed trendency. The concentration indexes of the baseline year and the first ，second，third year after the implementation of policy were －0.198，－0.186，－0.181，－0.202，the policy contribution rates of which were 0，－1.335％，－4.507％ and 1.936％；and the policy contribution rates in the change of the yearly concentration index were 20.8％，95.0％ and 57.6％. CONCLUSIONS ：The implementation of the full coverage policy for essential medicines is conducive to improving the equity of the medicine expenditure burden. The effect is affected by the implementation of policies and supporting systems ，but the comprehensive promotion of the equity of medicine requires multi-policy synergy.
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OBJECTIVE: To assess the accessibility of essential medicines in medical institutions at all levels in Liaoning province, and provide reference for the improvement of related policies. METHODS: The WHO/HAI standardized approach adjusted based on China′s national conditions was adopted. The availability, median price ratio (MPR) and disease burden per capita income were used as evaluation indicators and methods. RESULTS: ① Fifty-two percent (52%) of the surveyed drugs′ availability is lower than the international general standard (50%); there was a significant difference in the availability of sample drugs at all levels of medical institutions. The specific performance was primary (27.3%) 0.05). ③In rural and urban areas, seventy-seven percent(77%) and ninety-two percent(92%) of essential medicines each have a course of treatment cost that is less than the WHO referenced standard, respectively. CONCLUSION: Under the premise that the affordability of essential medicines is good, the availability of primary medical institutions is the lowest among surveyed institutions. In order to ensure the fairness and accessibility of essential medicines, it is suggested to strengthen the supply of essential drugs for primary-level medical institutions.
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OBJECTIVE： To provide the empirical basis for improving full coverage policy of essential medicines in China and promoting the fairness and accessibility of medicine. METHODS： Taking Taizhou diabetes essential medicines full coverage policy as an example， the electronic health records of diabetic patients in Taizhou city from 2011 to 2017 were collected， and the cost burden of patients was evaluated by whether catastrophic expenditure of family drugs had occurred. The concentration index was used to analyze the fairness of catastrophic expenditure on household medicines， and the effects of various influencing factors on the fairness of local medicine expenditure affordability were evaluated by year-by-year comparing the relevant indexes from baseline year to the third year of policy implementation. RESULTS & CONCLUSIONS： The concentration index of catastrophic expenditure on household medicines is negative from baseline year to the third year of policy implementation， which indicates that catastrophic expenditure on household medicines for diabetic patients in Taizhou mainly occurs in low-income groups. From the result of decomposition of concentration index， among the factors that affect the fairness of catastrophic expenditure on drugs in diabetic families， the contribution rate of “taking free essential medicines” keeps at top five places year by year， and the contribution value is positive， which shows that the implementation of policies is conductive to reducing the unfairness of catastrophic expenditure on household medicines in low-income families. Full coverage policy of essential medicines effectively improves the fairness of medicine expenditure affordability. In addition， scientific and reasonable essential medicines selection mechanism， the guarantee level of the policy， collaboration with multiple factors should be promoted so as to improve the fairness and accessibility of essential medicines.
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@#Background: This study is aimed to analyse the availability, prices and affordability of medicines for ischaemic heart disease (IHD) in Bangi, Selangor, Malaysia. Methods: A quantitative research was carried out using the methodology developed by the World Health Organization and Health Action International (WHO/HAI). The prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used as the standard of the affordability for the medicines. In this study, ten medicines of the IHD were included. The data were collected from 10 private medicine outlets for both originator brand (OB) and lowest-priced generic brand (LPG) in Bangi, Selangor. Results: From the results, the mean availability of OB and LPG were 30% and 42%, respectively. Final patient prices for LPG and OB were about 10.77 and 24.09 times their IRPs, respectively. Medicines that consumes more than a day’s wage are considered unaffordable. Almost half of the IHD medications cost more than one day’s wage. For example, the lowest paid unskilled government worker would need 1.4 days’ wage for captopril, while 1.2 days’ wage to purchase enalapril for LPG. Meanwhile, for OB, the costs rise to 3.4 days’ wage for amlodipine and 3.3 days’ wage for simvastatin. Conclusion: The findings of this study emphasise the need of focusing and financing, particularly in the private sector, on making chronic disease medicines accessible. This requires multi-faceted interventions, as well as the review of policies and regulations.
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Introducción: asegurar la asequibilidad de la población a una alimentación saludable requiere abordar la conformación y el seguimiento del valor de una canasta saludable de alimentos y de los precios diferenciales de alimentos según calidad nutricional. Objetivos: diseñar una canasta saludable de alimentos (CSA) que resulte consistente con las Guías Alimentarias para la Población Argentina (GAPA). Los objetivos específicos son la definición de un índice de calidad nutricional de alimentos y bebidas, la conformación de la CSA por grupos de alimentos, su valoración económica, y comparar la calidad nutricional y los precios de alimentos disponibles en el mercado. Metodología: el marco metodológico se basó en las GAPA y el concepto de densidad nutricional. Para definir el Índice de densidad nutricional (IDN) de alimentos se consideraron 9 nutrientes esenciales (proteínas, fibra, calcio, hierro, zinc, potasio, Vitaminas A, C y B9), 3 nutrientes críticos (azúcares, sodio y ácidos grasos saturados), el contenido de almidón, y las ingestas recomendadas del Institute of Medicine (IOM). Se elaboraron especificaciones sobre cantidades, variedad y calidades de alimentos para la CSA según grupo de alimentos. Los precios fueron registrados en comercios de la Ciudad y partidos aledaños de Buenos Aires. Resultados: al aplicar el IDN a un conjunto de 320 alimentos y bebidas consumidos por la población argentina, se los clasificó en tres terciles de calidad. El ordenamiento resultante es consistente con las recomendaciones de las GAPA. El valor de la CSA fue de $ 3759.- mensuales (marzo 2018) para la unidad de referencia de 2000 kcal. Al comparar las densidades de nutrientes y precios de los alimentos, hortalizas feculentas, huevo y legumbres son las categorías con mejor relación calidad nutricional/precio. Los alimentos de mejor calidad nutricional tienen un precio de $ 14.- por 100 kcal y los de calidad mínima $ 4,5.- Discusión: la CSA y el IDN son herramientas para orientar y evaluar políticas que promuevan una mejor calidad de dieta.
Introduction: ensuring the population's accessibility to a healthy diet requires addressing the conformation and monitoring of the value of a healthy food basket and the differential prices of foods following nutritional quality. Objectives: to design a healthy food basket (HFB) consistent with the recommendations given by Argentina's dietary guidelines (GAPA). The specific objectives were to define a nutritional quality index for foods and beverages, the composition of HFB by food group, assess values, and compare the prices and nutritional quality of foods available in local markets. Methods: the methodological framework was based on GAPA and the concept of nutritional density. To define the Nutritional Density Index (NDI) of food, 9 essential nutrients (proteins, fiber, calcium, iron, zinc, potassium, Vitamins A, C and B9), 3 critical nutrients (sugars, sodium and saturated fatty acids), the starch content, and the recommended intakes of the Institute of Medicine (IOM) were considered. Specifications were prepared on quantities, variety and qualities of food for the HFB, according to the food group. The prices were registered in shops in the City Centre (CABA) and neighboring municipalities of Buenos Aires. Results: when applying the NDI to a set of 320 foods and beverages consumed by the Argentine population, they were classified into three tertiles of quality. The resulting order is consistent with the recommendations of GAPA. The value of the HFB was $ 3759.- monthly (March 2018) for the reference unit of 2000 kcal. When comparing nutrient densities and food prices, starchy vegetables, eggs and legumes are the categories with the best nutritional quality / price ratio. The foods of better nutritional quality have a price of $ 14.- per 100 kcal and those of minimum quality $ 4.5.- Discussion: the HFB and NDI are tools to guide and evaluate policies that promote a better diet quality.
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OBJECTIVE:To evaluate the affordability of 3 anti-tumor targeted drugs gefitinib,trastuzumab and sunitinib in ur-ban and rural residents of Hubei province,and to provide reference for medical insurance price admission of anti-malignant tumor targeted drugs in China. METHODS:Referring to the incidence of malignant tumor stated in statistical yearbook of Hubei province and income data of urban and rural residents in Hubei province,based on the policy of reducing the price of imported drugs by 50% mentioned in the national drug price negotiations,and assume the drugs are included in the medical insurance reimbursement list,WHO/HAI standard survey method,catastrophic expenditure evaluation method and poverty effect evaluation method were ad-opted to calculate the affordability of 3 drugs. RESULTS:According to WHO/HAI standard survey method,increment of payment for 3 drugs were 64.00%-74.00% before and after 50% discount and reimbursement. According to catastrophic expenditure evalua-tion method,50% discount of gefitinib and reimbursement gefitinib,trastuzumab and sunitinib in urban area would result in cata-strophic expenditures of 20.00%、59.28% and 35.48% patients;in rural area,would result in catastrophic expenditures of 50.63%、74.72% and 75.93% patients. According to poverty effect evaluation method,50% discount of 3 drugs and reimbursement caused less than 31.95% urban and rural patients falling to poverty. CONCLUSIONS:Fifty percentage discount of 3 anti-tumor targeted drugs mentioned in the national drug price negotiations cause the economic burden more serious for rural residents than urban resi-dents. In the formulation of policies,the corresponding reimbursement ratio should be adjusted according to urban and rural areas, drug price and disease types for a balance of patients with different economic burden.
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Objective:To investigate the affordability of chronic diseases and drug use in families three prov-inces in western China. Methods: Questionnaire survey was conducted in 6 cities in 3 west provinces of China—Guangxi,Shanxi and Sichuan. In each province,one provincial capital city and one medium-sized city were select-ed. 2 community health service centers,2 secondary hospitals and 2 tertiary hospitals were selected from each city as the survey sites. Questionnaire was designed and pre-tested in advance,and delivered to sample patients'families in survey sites by face-to-face interview. Results:Totally 900 questionnaires were sent out,and 838 were effectively re-ceived with effective recovery of 93.11%. 97.85% of patients participated in various medical insurance. The aver-age health expenditure of households was 1 364.84 yuan per month and accounted for 37.43% of the total expendi-ture;chronic diseases expenditure was 700.34 yuan per month and accounted for 51.31% of the total health expend-iture. The average monthly drug expenditure was 628.74 yuan and represented 16.73% of the total household ex-penditure. Surveyed family members mainly suffered from chronic diseases,hypertension and diabetes,and the heav-iest disease burden in families came from ischemic heart disease and chronic kidney disease. Different provinces, provincial capitals and non-provincial cities,and different levels of medical institutions have a greater difference in drug burden. Patients have experienced the effect of medical reform,but not familiar with the specific health care reform poli-cies. Conclusions and Suggestions:The surveyed patients'families were basically involved in the Medicare,but the burden of family medication for patients with chronic diseases was still heavy. Therefore,government should take further measures to improve the proportion of chronic diseases outpatient and reduce the burden of medication costs.
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Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To analyze the change of cigarette consumption price,and understand the cigarette affordability in China.Methods A total of 16 800 households were selected through multi-stage stratified cluster sampling.Then IPAQ was used to randomly select one family member to conduct the survey.Questionnaire from Global Tobacco Surveillance System with added country-specific questions was used.Results Up to 50％ of current smokers would buy 20 cigarettes with price of 9.9 yuan (RMB) or less,and 25％ of current smokers would not buy 20 cigarettes with price exceed 5.5 yuan (RMB).Only 10％ would buy 20 cigarettes with price over 19.9 yuan (RMB).The calculated median monthly expenditure for cigarettes was 181.4 yuan (RMB).From 2010 to 2015,the proportion of annual expenditure for cigarettes in disposable income per capita declined from 10.5％ to 8.8％ in urban area and from 21.1％ to 17.3％ in rural area.Conclusion During 2010-2015,the purchasing power of Chinese smokers increased in both urban area and rural area due to the decrease of cigarette consumption price.
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Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To analyze the change of cigarette consumption price,and understand the cigarette affordability in China.Methods A total of 16 800 households were selected through multi-stage stratified cluster sampling.Then IPAQ was used to randomly select one family member to conduct the survey.Questionnaire from Global Tobacco Surveillance System with added country-specific questions was used.Results Up to 50％ of current smokers would buy 20 cigarettes with price of 9.9 yuan (RMB) or less,and 25％ of current smokers would not buy 20 cigarettes with price exceed 5.5 yuan (RMB).Only 10％ would buy 20 cigarettes with price over 19.9 yuan (RMB).The calculated median monthly expenditure for cigarettes was 181.4 yuan (RMB).From 2010 to 2015,the proportion of annual expenditure for cigarettes in disposable income per capita declined from 10.5％ to 8.8％ in urban area and from 21.1％ to 17.3％ in rural area.Conclusion During 2010-2015,the purchasing power of Chinese smokers increased in both urban area and rural area due to the decrease of cigarette consumption price.
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Abstract Within the framework for the realization of the human right to water and sanitation, States have the obligation to implement programs and public policies that satisfy the basic needs of their population, especially its most vulnerable demographics. In Colombia, this challenge has been addressed through policies that provide a determined essential amount of free water to people whose access to water and sanitation services are limited due to low income. Through a review of legal and technical documents as well as relevant literature, this article presents an analysis of the particular determinants involved in implementing this program in Bogotá and Medellín, as well as some related concerns. Among such factors, we discuss the evolution and changes of the tariff model used in service provision, estimates of basic consumption, the role of social movements and collective action, and user disconnection due to non-payment. The main particularities and differences of each case highlighted the inconveniences related to the method of identifying eligible users and applying assistance to beneficiary user groups, and the need for national guidelines in implementing this policy.
Resumo No marco da realização do direito humano à água e ao esgotamento sanitário os Estados têm a responsabilidade de implementar programas e políticas públicas que visam a satisfazer as necessidades essenciais da população, especialmente a mais vulnerável. Na Colômbia tem se abordado esse desafio mediante políticas que garantam o acesso em um volume vital, gratuito, para a população cuja capacidade de pagamento é limitada para ter acesso ao serviço de agua e esgotamento sanitário. Através de uma análise de conteúdo, baseado na legislação, documentos técnicos e revisão de literatura, nesse artigo se analisam os determinantes da implementação dessa medida em Bogotá e Medellín e suas particularidades, assim como se apontam algumas preocupações relacionadas. Entre os condicionantes se consideram a evolução e as mudanças do regime tarifário para a prestação do serviço, as estimativas dos consumos básicos, o papel dos movimentos sociais e da ação coletiva, e a desconexão pela incapacidade de pagamento dos usuários. A partir de cada caso e de suas principais diferenças foi possível evidenciar, entre outros inconvenientes, os relacionados com o método de identificação da população beneficiada e a necessidade de pautas a nível nacional para a implementação dessa política.
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Humans , Public Policy , Water Supply , Sanitation , Demography , ColombiaABSTRACT
Introduction: The particularly sorry plight of disadvantaged slum population with ample scope of further research into such areas as vulnerability to health risk and access to treatment, reduced economical choice and social support besides natural disasters and emotional stress of displacement. Material & Methods: An observational (cross-sectional) study was designed on a pre designed and pre tested questionnaire to understand women’s fertility and contraceptive behavior and to study Socio behavioral Determinants of Utilization of MCH services. Results: The prevalence of <18 marriage was 78.03%.The teenage pregnancy was as high as 46.36% with 47.90% having parity of 4 or more.And of those not seeking ANC 53.42% did not feel the need for care during pregnancy. A very important finding was that 64.23% had home delivery and of these, 74% did not have any trained birth attendant. Conclusion: Levels of education in the family, caste, affordability (asset-holding) and accessibility were the factors which determined the utilization pattern. In general, those with better levels of education and those with better affordability preferred private practitioners and were willing to travel longer distances to avail health services as there was more awareness, motivation and felt need.