Cost of delivering primary healthcare services through public sector in India

Background & objectives: Public health spending on primary healthcare has increased by four times (in real terms) over the last decade and continues to constitute more than half of the total public health expenditure. The present study estimated the cost of providing healthcare services at sub centre (SC) and primary health centre (PHC) level in four selected States of India. Methods: A total of 51 SCs and 33 PHCs were selected across the four States (Himachal Pradesh, Odisha, Kerala and Tamil Nadu) of India. The economic cost of delivering health services at these facilities was assessed using bottom-up costing methodology during the reference year of 2014-2015. The cost of capital items was annualized and allocation of shared resources was based on appropriate apportioning statistics. Results: The mean annual cost of providing health services at SC and PHC was ? 0.69 million (US$ 11,392) and ? 5.1 million (US$ 83,837), respectively. Nearly 3/4th and 2/3rd of this cost at the level of SC (74%) and PHC (63%) were spent on salaries. In terms of unit cost, the costs per antenatal care and postnatal care visit were ? 221 (173-276) and ? 333 (244-461), respectively, at SCs. Similarly, the costs of per patient outpatient consultation and per bed day hospitalization at PHC level were ? 121 (91-155) and ? 1168 (955-1468), respectively. Interpretation & conclusions: The cost estimates from the present study can be used in economic evaluations, assessing technical efficiency and also for providing valuable information during scale-up of health facilities.

Cost of National Vector Borne Disease Control Programme in North India

Background & objectives: Despite significant resources being spent on National Vector Borne Disease Control Programme (NVBDCP), there are meagre published data on health system cost upon its implementation. Hence, the present study estimated the annual and unit cost of different services delivered under NVBDCP in North India. Methodology: Economic cost of implementing NVBDCP was estimated based on data collected from three North Indian States, i.e. Punjab, Haryana and Himachal Pradesh. Multistage stratified random sampling was used for selecting health facilities across each level [i.e. subcentres (SCs), Primary Health Centres (PHCs), community health centres (CHCs) and district malaria office (DMO)] from the selected States. Data on annual consumption of both capital and recurrent resources were assessed from each of the selected facilities following bottom-up costing approach. Capital items (equipment, vehicles and furniture) were annualized over average life span using a discount rate of 3 per cent. The mean annual cost of implementation of NVBDCP was estimated for each level along with unit cost. Results: The mean annual cost of implementing NVBDCP at the level of SC, PHC and CHC and DMO was ? 230,420 (199,523-264,901), 686,962 (482,637-886,313), 1.2 million (0.9-1.5 million) and 9.1 million (4.6-13.5 million), respectively. Per capita cost for the provision of complete package of services under NVBDCP was ? 45 (37-54), 48 (29-73), 10 (6-14) and 47 (31-62) at the level of SC, PHC, CHC and DMO level, respectively. The per capita cost was higher in Himachal Pradesh (HP) at SC [? 69 (52-85)] and CHC [? 20.8 (20.7-20.8)] level and in Punjab at PHC level [? 89 (49-132)] as compared to other States. Interpretation & conclusions: The evidence on cost of NVBDCP can be used to undertake future economic evaluations which could serve as a basis for allocating resources efficiently, policy development as well as future planning for scale up of services.

Impacto económico de los inhibidores en hemofilia tipo A pediátrica / Economic impact of inhibitors in pediatric hemophilia type A

Resumen Introducción: Pocos estudios han evaluado el impacto económico de los inhibidores en hemofilia tipo A en México, especialmente en población pediátrica. Objetivo: Determinar el impacto económico que conlleva el desarrollo de inhibidores en pacientes pediátricos con hemofilia tipo A. Método: Se evaluaron de forma retrospectiva los pacientes con hemofilia tipo A atendidos en un servicio de hematología pediátrica entre diciembre de 2015 y noviembre de 2017, y se determinaron los costos directos e indirectos a partir de la presencia o ausencia de inhibidores. Resultados: El análisis de costos de la población estudiada (n = 24) mostró que el diagnóstico, seguimiento, profilaxis, tratamiento y hospitalización de estos pacientes tuvo un costo de $6 883 187.4 anuales por paciente, de los cuales más de 95 % dependió del uso de factores hemostáticos. El costo anual por paciente en el grupo con inhibidores tuvo un costo de $5 548 765.0, en comparación con $1 334 422.4 del grupo sin inhibidores, 4.2 veces superior. Conclusiones: Se trata del primer estudio nacional que muestra que el desarrollo de inhibidores en pacientes pediátricos con hemofilia tipo A eleva más de cuatro veces la erogación económica derivada de esta enfermedad.

Abstract Introduction: Few studies have assessed the economic impact of inhibitors in hemophilia A in Mexico, especially in the pediatric population. Objective: To determine the economic impact entailed by the development of inhibitors in pediatric patients with hemophilia A. Method: Patients with hemophilia A under the care of a pediatric hematology department between December 2015 and November 2017 were retrospectively assessed. Direct and indirect costs were determined based on the presence or absence of inhibitors. Results: The cost analysis of the study population (n = 24) showed that diagnosis, follow-up, prophylaxis, treatment and hospitalization of these patients had an annual cost of $ 6 883 187.4 per patient, out of which more than 95 % depended on the use of hemostatic factors. Annual cost per patient in the group with inhibitors was $ 5 548 765.0 in comparison with $ 1 334 422.4 in the group without inhibitors, 4.2 times higher. Conclusions: This is the first national study to show that the presence of inhibitors in pediatric patients with hemophilia A increases the cost of the disease more than four times.

Cost comparisons of five leading brands of the antihypertensive drug, Telmisartan, available in an Indian city

Background: Antihypertensive drugs have to be taken lifelong, after initiation of the treatment. Price variation can lead to huge economic burden on the patients of hypertension, especially when cost considerations are not undertaken by the prescribing physician . This study was undertaken to compare the annual cost , to the patient , of five different most commonly prescribed brands of Telmisartan 40 mg, in Kolhapur city.Methods: Authors purchased a strip of 10 tablets each of the five leading brands in one city, Kolhapur, India, of Telmisartan 40 milligram. The prices of the strip of 10 tablets of each of the five selected brands were compared. In turn the annual cost of each of these five, was compared directly as well as using percentages. The data was collected, analysed and presented.Results: The data of the cost of the preparations of five different brands of a single antihypertensive drug, Temisartan 40 milligram shows that the annual cost of the costliest among the three brands of this drug is almost three times , that of the cheapest brand, or in other words almost 300 percent that of the cheapest brand.Conclusions: the cost variation amongst the five brands was considerable. India being a country with a major chunk of the population being very price sensitive, the prescribing physician must select the brand carefully. The most costly preparation of Temisartan can significantly add to the burden on the patient’s annual budget. Thus, Pharmacoeconomics must take an important place while prescribing medicines, especially in a country like India.

Acupuncture price in forty-one metropolitan regions in the United States: An out-of-pocket cost analysis based on OkCopay.com / 中西医结合学报

Few studies have focused on the cost of acupuncture treatments although acupuncture has become popular in the United States (U.S.). The purpose of the current study was to examine the out-of-pocket costs incurred from acupuncture services based on an online website, OkCopay.com. We examined descriptive statistics (range, median and 20% intervals) for the cost of acupuncture "first-time visits" and "follow-up visits" in 41 metropolitan regions in the U.S. The acupuncture prices of 723 clinics throughout 39 metropolitan regions were included, except for Birmingham, Alabama and Detroit, Michigan as there was no online data available at the time of the study for these two regions. The cost range for a first-time acupuncture visit was $15-400; the highest median was $150 in Charleston, South Carolina, while the lowest was $45 in St. Louis, Missouri. The top 10 cities for the highest median were: Baltimore, Washington, D.C., New York, San Francisco, San Jose, Boston, Atlanta, Seattle, Portland and Indianapolis, with the median $120, while the median for all 723 clinics was $112. For the follow-up visits, the cost range was $15-300; the highest median was $108 in Charleston, South Carolina, and the lowest $40 in Miami, Florida. The 10 cities with highest median follow-up acupuncture visit costs were: New York, Baltimore, New Orleans, Washington, D.C., Philadelphia, San Francisco, San Jose, Seattle, Boston and Atlanta, with the median $85, while for all 723 clinics the median price was $80. The estimation of the average gross annual income of each acupuncturist from the regions studied was $95,760, while the total annual cost of patients seeking acupuncture services in the U.S. was about $3.5 billion in 2018.