Hospital unit costs in Jordan: insights from a country facing competing health demands and striving for universal health coverage.

BACKGROUND: Public providers in Jordan are facing increasing health demands due to human crises. This study aimed to benchmark the unit costs of hospital services in public providers in Jordan to provide insights into the outlook for public health care costs. METHODS: The unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using the standard average costing method (top-down) for the fiscal year 2018-2019. The unit costs per inpatient day were estimated for nine specialities and staff in Jordanian dinars (exchange rate JOD 1 = USD 1.41). RESULTS: The average unit cost per admission in Jordan was JOD 782.300 (USD 1101.80), the per inpatient day cost was JOD 236.600 (USD 333.20), the per bed day cost was JOD 172.900 (USD 244.90), the per outpatient visit cost was JOD 58.400 (USD 82.30), the per operation cost was JOD 449.600 (USD 633.20) and the per emergency room visit cost was JOD 31.800 (USD 44.80). The specialities of ICU/CCU and OB/GYN presented the highest unit costs per inpatient day across providers: JOD 377.800 (USD 532.90) and JOD 362.600 (USD 510.70), respectively. The average salaried unit cost of staff depended mainly on year of employment. Nonetheless, the unit costs varied depending on the service utilization, type of service and organizational outlet. CONCLUSIONS: Knowledge of how unit costs vary across public providers in Jordan is essential to outline cost control strategies and inform future research. Institutionalization of the cost information system and high-level governmental support are necessary to generate a routine practice of collecting and sharing cost information.

Perceived Public Stress Among Jordanians During the COVID-19 Outbreak.

OBJECTIVES: Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak. METHODS: Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS. RESULTS: The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student's worry regarding their studies/graduation. Perceived stress was decreased if participants' self-rated health status score increased. CONCLUSIONS: In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

Epidemiology of women diagnosed with breast cancer in Jordan: A 5-year survival analysis and patients' characteristics from 2 public hospitals.

OBJECTIVES: To evaluate the epidemiology, prognostic factors, and 5-year overall survival (OS) of females with breast cancer (BC) diagnosed between 2011 and 2014 in Jordan. METHODS: A retrospective medical review of females who were diagnosed with BC between 2011 and 2014 at the 2 leading public health providers in Jordan was performed. The endpoint of the study was 2018. Data were extracted from the medical files between 2011 and 2018, including demographic clinical data on the patient level. Survival by age, laterality, grade, stage, and treatments modes were calculated by the Kaplan Meier method. RESULTS: A total of 877 women were included with median age of 51 years and follow-up duration of 2.4 years. Majority of the patients had ductal carcinoma and estrogen receptor (ER) positive type. The 5-year OS for patients with stage I, II, III, and IV, 94%, 86%, and 46% (p<0.001), respectively. The tumor stage and nodal status were the main prognostic variables affecting the overall survival. CONCLUSION: The incidence in Jordan is increasing, yet survival rates are improving with increased diagnosis during early stages. Therefore, strategies for implementing universal screening programs are advocated to improve clinical outcomes and to reduce the disease burden.

Direct medical costs of breast cancer in Jordan: cost drivers and predictors.

Introduction: Breast cancer is the most common cancer amongst females in Jordan. The study aimed to estimate the total direct medical cost of breast cancer from a healthcare provider's perspective.Methods: A retrospective cohort study was done to include all Jordanian females who were diagnosed with breast cancer at two leading public providers of cancer care in Jordan, Bashir Hospital and the University of Jordan Hospital. Data were extracted from the Jordan Cancer Registry (JCR) from 2011 to 2014 including demographic, clinical, and economic data of the patient.Results: A total of 877 and 665 patients were included in the first and second year after diagnosis, respectively. Costs increased in the advanced stages; costs for stages 0, I, II, III, and IV were Jordanian dinars)JD(6,749.94 ($9,517.42), JD 5,960.46 ($8,404.25), JD 8,003.58 ($11,285.05), JD 9,390.59 ($13,240.73), and JD 9,587.44 ($13,518.29), respectively. Treatment costs were the main cost driver across all stages.Conclusions: This analysis offers insight into costs, cost drivers, and resources utilization incurred by breast cancer patients in Jordan. Two major hospitals in Jordan can play a key informative role in future cost-effectiveness of breast cancer screening and therapeutic treatments in the different stages of cancer.

Cost-effectiveness of pharmacist-led care versus usual care in type 2 diabetic Jordanians: a Markov modeling of cardiovascular diseases prevention.

BACKGROUND: Cardiovascular diseases (CVDs) are responsible for one third of global deaths and the main cause of death among Jordanians. Pharmacist-led care was outlined previously as a cost-effective approach in the management of chronic illness; however, this is not well studied in low to middle-income countries. AIM AND OBJECTIVES: To assess the cost-effectiveness of pharmacist-led care versus usual care in preventing CVDs in Type 2 Diabetes Mellitus (T2DM). METHOD: A Markov model of one-year cycle length and 10-year time horizon was constructed to simulate 10-year CVD events, mortality, and costs for two hypothetical cohorts; usual care and pharmacist-led care, respectively, of Jordanian patients suffering from T2DM. Public health provider perspective was adopted. Outcomes examined were incremental costs, LYGs, and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis (PSA) assessed the robustness of the results. RESULT: The pharmacist-led care generated an additional 0.3 LYG/patient at an additional cost of JD1,238.78 (US$1,747.24) comparing to the usual care in the 10-year base-case analysis. Deterministic and PSA supported the robustness of base-case findings, indicating that pharmacist-led care is cost-effective. CONCLUSION: The findings outline long-term clinical and economic benefits of expanding clinical pharmacist's roles in direct patient care services.

Awareness, knowledge, and attitudes of health professions students toward health economics and pharmacoeconomics education in Jordan.

INTRODUCTION: Health economics education (HEe) and pharmacoeconomics education (PEe) in the Middle East and North Africa area is growing, particularly in pharmacy education. Little is known about the awareness, knowledge, and attitudes of health professions students toward health economics (HE) and pharmacoeconomics (PE) and the extent of education they receive before joining the workforce. METHODS: A self-completed validated questionnaire was distributed to students from medical, dental, pharmacy, and nursing schools in Jordan. The questionnaire assessed awareness, knowledge, and attitudes about HE and PE terminologies, applications, and need for training. Chi-square and Kruskal-Wallis H tests were used to outline the differences between students' responses. RESULTS: A total of 2648 questionnaires were analysed, representing 586 medical, 414 dental, 1080 pharmacy, and 568 nursing students. Approximately 65% of respondents reported they had heard of HE or PE. Supportive views about the necessity for economic education in healthcare professions curricula were reported. Nursing students most often expressed desire to undertake training before graduation while dental students showed the least interest. CONCLUSIONS: Students across health professions groups acquire various extents of HEe and PEe before graduation. Pharmacy schools demonstrated leading interest and progress in providing PEe in Jordan, and medical schools appeared to follow. Both dental and nursing schools were lagging. Regional support from the International Society for Pharmacoeconomics and Outcomes Research Arabic Network, accreditation, and regulatory requirements are leading social and contextual contributors to PEe in Jordan.

Role of Pharmacists in COVID-19 Disease: A Jordanian Perspective.

OBJECTIVES: The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission. METHODS: A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists' knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19. RESULTS: Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5). CONCLUSIONS: Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.