A media content analysis of New Zealand's district health board Population-Based Funding Formula.

AIM: The Population-Based Funding Formula (PBFF) has a significant impact on health funding distribution between New Zealand's 20 district health boards (DHBs) yet is subject to little independent oversight or public scrutiny. There has been widespread dissatisfaction among DHBs with the allocation process; however, there are limited formal avenues available for DHBs and the public to discuss the PBFF. As such, the news media has become a key platform for voicing concerns. This study aims to gain a better understanding of how the PBFF is portrayed in the news media and of perceptions of funding allocations across the country. METHOD: We conducted thematic analyses of 487 newspaper articles about the PBFF, published over 13 years from 2003-2016. We then identified trends in the data. RESULTS: Typically presented in a negative light, the PBFF was commonly framed against a background of financial struggle and resultant impacts on health services and staff. The effect of factors driving DHB allocations and the PBFF process itself were also key themes. There were significant regional and temporal variations in reporting volume, with most articles focusing on South Island DHBs and occurring during the introduction of the PBFF and at the time of the most recent review. CONCLUSIONS: The findings suggest general discontent with the PBFF model across the DHB sector and a sense that the PBFF has failed to address various challenges facing DHBs. The geographic imbalance in reporting volume suggests that frustration with the PBFF is particularly keenly felt in the South Island. Although the PBFF is a lightning rod for frustrations over limited health funding, the findings point to the need to improve transparency and dialogue around the formula and to monitor of the impact of PBFF allocations throughout the country.

Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings.

Bacterial sepsis is an important cause of mortality in low- and middle-income countries, yet distinguishing patients with sepsis from those with other illnesses remains a challenge. Currently, management decisions are based on clinical assessment using algorithms such as Integrated Management of Adolescent and Adult Illness. Efforts to develop and evaluate point-of-care tests (POCTs) for sepsis to guide decisions on the use of antimicrobials are underway. To establish the minimum performance characteristics of such a test, we varied the characteristics of a hypothetical POCT for sepsis required for it to be cost-effective and applied a decision tree model to a population of febrile patients presenting at the district hospital level in a low-resource setting. We used a case fatality probability of 20% for appropriately treated sepsis and of 50% for inappropriately treated sepsis. On the basis of clinical assessment for sepsis with established sensitivity of 0.83 and specificity of 0.62, we found that a POCT for sepsis with a sensitivity of 0.83 and a specificity of 0.94 was cost-effective, resulting in parity in survival but costing $1.14 less per live saved. A POCT with accuracy equivalent to the best malaria rapid diagnostic test was cheaper and more effective than clinical assessment.

Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.