Cost Analysis of Diagnosis and Treatment of Tobacco-Related Cancer.

BACKGROUND: Tobacco use is the leading cause of cancer, accounting for approximately 20% of all cancer deaths and 70% of lung cancer deaths worldwide. The use of tobacco has multiple consequences; it damages health and pushes the household below the poverty line. The treatment of cancer is very costly. The study attempts to determine the cost associated with the diagnosis and treatment of tobacco-related cancer in Nepal. METHODS: A descriptive cross-sectional study was conducted among 103 patients from public and private hospitals in 2019. Patients with the second and third stages of cancer who had ever used tobacco were randomly selected for the study purpose. All patients who met the inclusion criteria were selected for interviews. The data were analyzed using SPSS version 22, and summarized in descriptive form only. RESULTS: The total cost of tobacco-related cancer was NPR 9,81,370 per patient in 2019. A patient's average direct medical cost was found to be NPR 5,88,740 (60%), whereas the average direct non-medical cost was NPR 1,23,147(13%). The wage loss as a result of illness accounted for over one-fourth (27%) of the total cost. Approximately one-sixth of the patients sold their property for the treatment of cancer. The majority of the cancer patients were found to be illiterate or with primary education only, and financially dependent on their families. CONCLUSIONS: Treatment of cancer is costly and patients in Nepal can hardly afford the expenses. Enrolling clients in health insurance and increasing the government subsidy by raising the tax on tobacco products can be a long-term source of health financing to protect patients from sliding into poverty. The increased price of tobacco due to an increase in tax would reduce tobacco consumption, particularly among youth and the poor.

Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia.

Introduction: Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health. Methods: A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived. Findings: Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account. Discussion and Conclusion: Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.

What drives health policy formulation: insights from the Nepal maternity incentive scheme?

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005. We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.