Modelling the economic burden of SARS-CoV-2 infection in health care workers in four countries.

Health care workers (HCWs) experienced greater risk of SARS-CoV-2 infection during the COVID-19 pandemic. This study applies a cost-of-illness (COI) approach to model the economic burden associated with SARS-CoV-2 infections among HCWs in five low- and middle-income sites (Kenya, Eswatini, Colombia, KwaZulu-Natal province, and Western Cape province of South Africa) during the first year of the pandemic. We find that not only did HCWs have a higher incidence of COVID-19 than the general population, but in all sites except Colombia, viral transmission from infected HCWs to close contacts resulted in substantial secondary SARS-CoV-2 infection and death. Disruption in health services as a result of HCW illness affected maternal and child deaths dramatically. Total economic losses attributable to SARS-CoV-2 infection among HCWs as a share of total health expenditure ranged from 1.51% in Colombia to 8.38% in Western Cape province, South Africa. This economic burden to society highlights the importance of adequate infection prevention and control measures to minimize the risk of SARS-CoV-2 infection in HCWs.

Hospitalization Costs for Diabetes Related Lower Extremity Amputation at a Referral Hospital in KwaZulu Natal, South Africa.

BACKGROUND: Diabetes mellitus is a significant risk factor for lower extremity amputations (LEA), both alone and in combination with peripheral vascular disease and infection. Currently, in Africa, more than half of the cases do not meet the recommended blood glucose control levels to prevent complications suggesting that the risk of complications is high. OBJECTIVE: The study aims to estimate hospitalization costs of diabetes-related lower extremities amputation for patients consulted at a referral hospital in 2015/16. METHODS: The study was a retrospective analysis using a mixed costing approach and based on 2015/16 financial year data inflated to 2020 at a 32-bed vascular unit of a quaternary care health facility. Patient level data were extracted from the hospital information system for length of stay, medication provided, laboratory and radiological investigations, and other clinical services offered. RESULTS: The total summative cost for managing all 34 patients amounted to $ 568 407 or a mean unit cost per patient of $ 16 718 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 728 997 or $ 21 441 per patient. The mean unit cost per patient for foot amputation was $ 12 598 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 16 157 per patient, whilst the mean cost per patient for lower limb amputation was $ 16 718 based on 2015/16 prices, and when adjusted to 2020 prices, amounted to $ 21 441 per patient. CONCLUSION: Hospital costs associated with diabetes related amputation varied by whether the patient was admitted to intensive care unit or not, and the major cost drivers were general ward costs, compensation of employees, and radiology services. A comprehensive audit of the referral process and care process at the facility level as well as technical efficiency analysis, is required to identify inefficiencies that could reduce hospital costs for managing diabetes complications.

Prevalence, Patient Predictors, and Referral Patterns for Diabetes-Related Complications Treated at a Central Hospital in KwaZulu Natal.

PURPOSE: Poor diabetes control can result in short- and long-term neuropathic, microvascular, and macrovascular complications. In addition to the socioeconomic impact that diabetes and its complications has on patients, incremental financial costs are added to health-care systems. This study aimed to assess prevalence, patient-related factors, and referral patterns for patients with diabetes-related complications managed at Inkosi Albert Luthuli Central Hospital (IALCH) betweenJanuary 1, 2014 and December 31, 2015. METHODS: The retrospective cross-sectional study was done on all adult patients (aged >18 years) with diabetes consulted at IALCH. Primary outcome measures were the proportion with diabetes-related complications and the source of referrals. Logistic regression analysis was done to identify predictors of diabetes complications. RESULTS: Of all adult diabetes patients consulted, 7,761 (47.4%) presented with one or more diabetes-related complications and 56% (4,321) had experienced macrovascular complications. Cardiovascular complications (2,576, 33%) were the most common complications, followed by peripheral vascular disease (1,755, 23%). Microvascular complications included retinopathy (1,656, 21%), nephropathy (118, 14%), and neuropathy (702, 9%). After multivariate analysis, all four factors (age >58 years, male sex, Indian ancestry, and non-insulin dependent diabetes mellitus remained statistically significant for an increased likelihood of developing cardiovascular complications. Indian ancestry was not associated with increased odds of peripheral vascular disease. CONCLUSION: Macrovascular diseases were the main complications. Older age, male sex, Indian ancestry, and non-insulin dependent diabetes mellitus were associated with macrovascular complications. A combination of health-promotion and behaviour-modification programs is required prior to or early in the disease course. Appropriate and more aggressive management at primary-care level using evidence-based clinical guidelines is essential to prevent complications.

Patient-level predictors of diabetes-related lower extremity amputations at a quaternary hospital in South Africa.

INTRODUCTION: Diabetes-related lower extremity amputation has a major psycho-social and economic cost on the patient as well as a direct impact on financial expenditure within health facilities. AIM: This study aimed to determine the incidence and patient-related factors related to diabetes-related amputations amongst patients that were referred to the quaternary hospital between 1 January 2014 and 31 December 2015. METHODS: A retrospective cohort study. Data were retrieved from the medical record for each diabetes patient that was managed at IALCH during the study period. The following variables were collected: sociodemographic parameters (age, gender, and ethnicity) and diabetes-related parameters (type of diabetes) and additional complications. RESULTS: Ninety-nine patients (0, 73%) of all diabetes patients managed were new diabetes-related lower-extremity amputations. There were statistically significant increased odds of female patients (OR: 1, 7) and patients with non-insulin dependent diabetes (OR: 1, 64) to have new diabetes-related amputations. Patients older than 60 years (OR: 1, 31); African patients (OR: 1, 35) patients with cardiovascular complications (OR: 1, 04) and patients with retinopathy (OR: 1, 48) were more likely to have diabetes-related amputations but not statistically significant. CONCLUSIONS: A combination of primary preventive strategies, early detection and appropriate management of patients with diabetes and specific guidelines on the frequency, clinical and laboratory tests required for early diagnosis and referrals with early signs of diabetes-related complicationsat primary care level will assist in reducing the long term adverse outcomes including amputations.