RESUMO
A major problem of burns is the high cost of management, as well as the discrimination and disability they can cause to patients. Maximising resource utilisation is of key importance for lower-middle-income countries (LMICs) like Nigeria. There is a need to know if Nigerian patients who were victims of burns get the best value for money. This study aimed to evaluate the average cost of managing burns in Nigeria, and determine if the treatment approach is cost-effective. The study was a cost-utility analysis from the perspective of health service providers in Nigeria, a case study of the National Orthopaedic Hospital Enugu (NOHE) using 2013 Microsoft excel. Data on the cost of burn management were obtained from a retrospective study conducted in NOHE in 2012 on 285 patients. Costs were adjusted to reflect the future (2015) value using a real interest rate of 3%. These costs were presented in 2015 US dollars, and a discount rate of 3% was used for both cost and outcome. Health outcome was presented in disability adjusted life years (DALYs). Based on a cost-effectiveness threshold of $2,758.4 (i.e. representing Nigerian GDP/capita), burn management is cost-effective in Nigeria ($526.68/DALY averted). The result also showed that the cost of managing burns in Nigeria is $7,123.28 per patient, which is more than the average income. Burn management in Nigeria is cost-effective but too expensive for most Nigerians to afford.
Un des problèmes de la prise en charge des brûlés est son coût, ainsi que la discrimination et le handicap que la brûlure peut entraîner. L'optimisation des ressources financières est d'une importance cruciale dans les pays en développement comme le Nigeria et il est nécessaire de savoir si les finances engagées se révèlent utiles. Cette étude a pour but d'évaluer le coût de prise en charge des brûlés au Nigeria, et d'évaluer l'efficacité du traitement, à partir des données de l'Hôpital Orthopédique National (HON) d'Enugu. Les données des 285 patients hospitalisés dans l'HON pour brûlures en 2012 ont été analysées. Les chiffres de 2012 ont été extrapolés à 2015 en tenant compte d'une inflation de 3%. L'état de santé après traitement a été chiffré en Espérance de Vie Corrigée de l'Incapacité (EVCI). Le coût de traitement d'une brûlure est de 7 123,28$ soit 526,68$ par année d'ECVI gagnée et la prise en charge des brûlés apparaît donc utile, en termes médico-économiques. Ce coût est cependant à rapporter au PIB per capita du Nigeria, qui est de 2 758,40$. La prise en charge des brûlés au Nigeria, bien que trop chère pour la plupart des nigérians, est efficace financièrement.
RESUMO
The aim of this study was to formulate and evaluate in vitro, ceftriaxone sodium lipospheres dispersions for oral administration. Ceftriaxone sodium lipospheres were prepared by melt-emulsification using 30%w/w Phospholipon 90H in Softisan 154 as the lipid matrix containing increasing quantities of PEG 4000 (10, 20, 30, and 40%w/w). Characterization based on particle size, particle morphology, encapsulation efficiency, loading capacity and pH were carried out on the lipospheres. Microbiological studies of the ceftriaxone sodium-loaded lipospheres were performed using Escherichia coli as the model organism. In vitro permeation of ceftriaxone sodium from the lipospheres through artificial membrane (0.22 microm pore size) was carried out using Franz cell and simulated intestinal fluid (SIF) without pancreatin as acceptor medium. Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month (Maximum size = 64.76 +/- 3.81 microm). Microbiological studies indicated that lipospheres formulated with 20%w/w of PEG 4000 containing 2%w/w or 3%w/w of ceftriaxone sodium gave significantly (p < 0.05) higher inhibition zone diameter than those with 30%w/w or 40%w/w of PEG 4000. The result also indicated that lipospheres with 10%w/w PEG 4000 resulted in significantly higher encapsulation efficiency (p < 0.05) while those with 30%w/w gave the least, while the loading capacity values ranged from 3.22 mg of ceftriaxone sodium/100 mg of lipid to 6.36 mg of ceftriaxone sodium/100 mg of lipid. Permeation coefficient values varied and ranged from 8.55 x 10(-7) cm/s to 2.08 x 10(-6) cm/s depending on the concentration of PEG 4000. The result of this study gave insight that the issue of ceftriaxone stability in oral formulation could be adequately addressed by tactical engineering of lipid drug delivery systems such as lipospheres.
