Exploring cost drivers to improve disease management: the case of type 2 diabetes at a tertiary hospital in Burundi, Africa.

Background: In Burundi, the International Diabetes Federation estimated the prevalence of diabetes mellitus (DM) as high as 2.4% in adults aged between 20 and 79 years old. Thus, the healthcare expenditure for the treatment of diabetic patients is considerably high. Objective: This study explores the economic burden of type 2 DM and its cost drivers at a tertiary hospital in 2018. It included adult type 2 DM patients who received treatment from a tertiary hospital (Hospital Prince Regent Charles) in 2018. In this study, 81 patients were included. Methods: Data on illness treatment and complications were collected through patient interviews and by reviewing patients' medical and financial records. A stepwise multiple linear regression model was used to explore factors affecting the cost of type 2 diabetes mellitus. Results: The average total cost per patient per year was estimated at $2621.06. The fitted cost model had an adjusted R2 of 0.427, which explained up to 43% of the variation in the total cost. The results suggest primary cost drivers such as treatment regimen, duration of the disease, payment method, and number of complications. Conclusion: The findings confirm the profound economic burden of type 2 DM and the need to improve patient care and prevent disease progression. The establishment of a special clinic for patients with diabetes is recommended, as is financial support for underprivileged patients. A specific focus on cost drivers could help establish appropriate disease management programs to control the costs for type 2 diabetes patients.

Exploring cost drivers for improving disease management: the case of type 2 diabetes at a tertiary hospital in Burundi, Africa

Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco using the interrupted time-series analysis. The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2= -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). The effect of thecovid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Cost-Utility Analysis of Community Case Management for Malaria Control in Burundi.

BACKGROUND: The community case management (CCM) program for malaria control is a community-based strategy implemented to regulate malaria in children in Burundi. This study compared the cost and utility of implementing the CCM program combined with health facility management (HFM) versus HFM alone for malaria control in children under five in Burundi. METHODS: This study constructed a five-year Markov model with one-week cycles to estimate cost-utility and budget impact analysis (BIA). The model defined 10 health states, simulating the progression of the disease and the risk of recurrent malaria in children under five years of age. Cost data were empirically collected and presented for 2019. Incremental cost per disability-adjusted life year (DALY) averted, and a five-year budget was estimated. One-way and probabilistic sensitivity analyses (PSAs) were then performed. RESULTS: From provider and societal perspectives, combining the CCM program with HFM for malaria control in Burundi was more cost-effective than implementing HFM alone. The addition of CCM, using artesunate amodiaquine (ASAQ) as the first-line treatment, increased by US$1.70, and US$ 1.67 per DALY averted from the provider and societal perspectives, respectively. Using Artemether Lumefantrine (AL) as the first-line treatment, adding the CCM program to HFM increased by US$ 1.92, and US$ 1.87 per DALY averted from the provider and societal perspectives. At a willingness-to-pay of one GDP/capita, the CCM program remained a 100% chance of being cost-effective. In addition, implementing the program for five years requires a budget of US$ 15 800 486-19 765 117. CONCLUSION: Implementing the CCM program and HFM is value for money for malaria control in Burundi. The findings can support decision-makers in Burundi in deciding on resource allocation, especially during the program's scale up.

Does the Choice of Health Metric, DALY or QALY, Influence Conclusions of Health Economic Evaluation? A Case Study of Rotavirus Vaccine in Burundi.

BACKGROUND: Two metrics, quality-adjusted life-year (QALY) and disability-adjusted life-year (DALY), have been commonly used to measure health benefits associated with health interventions. This study aimed to explore the effect of the choice of health metric (DALY or QALY) on economic evaluation conclusion. METHODS: A previous published model for a cost-utility analysis (CUA) of rotavirus vaccine was adapted to estimate the QALYs gained and DALYs averted from four rotavirus vaccines: Rotarix, RotaTeq, Rotavac, and Rotasiil. The study was conducted in both Burundi provider and societal perspectives over a five-year time horizon. Disability weights (DW) were derived from the Global Burden of Disease (GBD) study. Scenario analysis was performed to evaluate the impact of age weights and source of utility weight. RESULTS: In base-case analysis, the QALYs gained ranged from 46 to 78% of the DALYs averted. The incremental cost-effectiveness ratios (ICER) per QALY gained were higher than ICER per DALY averted by 28 to 113%, leading to less favorable cost effectiveness. The QALYs gained from using 1-DW as utility weight were slightly higher than those using EQ-5D utility weight obtained from previous literature, yet less likely to alter CUA conclusions. When age-weighting was incorporated in the DALY calculation, the ICERs per DALY averted were reduced leading to more favorable cost effectiveness. CONCLUSION: In case of rotavirus diarrhea, in which mortality burden is considered larger than morbidity due to short duration of disease, although the use of DALY consistently led to more favorable cost-effective result than the use of QALY such effects were considered small and less likely to affect the EE conclusion under current CET of 1 GDP per capita.

Economic burden on people living with HIV who attend self-help groups in Yangon, Myanmar.

This study aims to determine economic burden or cost of human immunodeficiency virus (HIV) and its consequences from patient perspective and to examine factors influencing the cost. This is a prevalence-based cost-of-illness (COI) study. A cross-sectional survey was carried out in Yangon, Myanmar during March and April 2018. Face-to-face structured interview was conducted among 264 people living with HIV (PLHIV) who were members of the selected four self-help groups (SHGs) that provided HIV peer support. Micro-costing approach was adopted for the cost calculation. Direct medical cost, direct non-medical cost and indirect cost were considered. Cost of HIV per patient in the year 2017 was estimated at 228.2 international dollar (Int$). Direct medical cost was only small portion of the total cost (5.6%). Indirect cost or cost of time loss was the largest contributor among the cost components, accounted for 61.2% of the total cost. First year of the antiretroviral therapy (ART) initiation and second line drug regimen have positive effect on the costs. HIV resulted in substantial economic burden for the patients. Effective interventions aim at reducing the economic burden on patients by providing compensation on transportation cost and providing job opportunity are essential. Further researchers examining cost from provider and societal perspectives are warranted to provide complete picture of the economic burden of HIV in Myanmar.

A comparison of six approaches for measuring utility values among patients with locally advanced cervical cancer.

BACKGROUND: Several instruments are available to measure health utility values. However, limited studies have not yet comprehensively assessed the agreement among these instruments. This study therefore aimed to investigate the performance and agreement of six instruments for utility measures: EQ-5D-3L, EQ-5D-5L (cTTO model), EQ-5D-5L (DCE model), EQ-5D-5L (Hybrid model), TTO, and VAS, among locally advanced cervical cancer (LACC) patients in Thailand. METHODS: We compared utility scores derived from six approaches using Friedman's test. We also assessed the agreement of utility scores between each pairwise comparison by intraclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The mean (SD) utility values derived from six approaches were as follows: 0.755 ± 0.248 (EQ-5D-3L), 0.801 ± 280 (TTO), 0.806 ± 0.156 (VAS), 0.871 ± 0.184 (cTTO model), 0.875 ± 0.168 (Hybrid model), and 0.900 ± 0.142 (DCE model). Significant differences across six approaches were found in Friedman's test. The ICC showed high agreement between EQ-5D-5L and EQ-5D-3L, and very high agreement between all three models of EQ-5D-5L. The Bland-Altman plots showed wide limit of agreement, except the pairwise comparison, between each model of the EQ-5D-5L. CONCLUSION: TTO, VAS, EQ-5D-3L and EQ-5D-5L could not be used interchangeably in LACC patients. The impact of using different instruments on economic evaluation findings warrants further investigation.

Factors affecting health-related quality of life of HIV-infected key population in Myanmar.

This cross-sectional study examined factors affecting Health-related Quality of Life (HRQoL) among 273 HIV-infected key populations. This included, men who have sex with men (MSM), people, who inject drugs (PWID), and sex workers (SW), who were currently receiving antiretroviral therapy (ART) in Myanmar. Participants were recruited from four non-government clinics in four main cities. Overall HRQoL score derived from the WHOQOL-HIV BREF questionnaire was 86.08 ± 10.78. The lowest score was found in the environment domain (13.64 ± 2.06), while the highest score was found in the spirituality domain (15.54 ± 3.04). According to the multiple logistic regression analysis, participants, reported having an adequate income (OR = 3.32, P = 0.006), regularly taking meditation (OR = 3.79, P = 0.009), living in Tachileik (OR = 15.43, P = 0.011), and reported having no symptoms during previous 2 weeks (OR = 14.50, P < 0.001), were more likely to have good HRQoL level. In contrast, patients receiving ART < 1 year (OR = 0.163, P = 0.028) reported having low ART adherence (OR = 0.17, P = 0.018) and reported anticipated stigma (OR = 0.23, P < 0.001) and internalized stigma (OR = 0.29, P = 0.006) were less likely to have good HRQoL level.

How Economic Analysis Increases the Awareness of Clinical Services: A Case of Diabetes Mellitus at a Teaching Hospital in Myanmar.

OBJECTIVES: Myanmar faces a growing epidemic of type 2 diabetes mellitus, which has significant impact on the individual health and health service system; nevertheless, reliable cost estimate for treating diabetes is still unknown. Therefore, this study aimed to explore the treatment cost of hospitalization by type 2 diabetes mellitus and the association of complications and comorbidities with the treatment cost. METHODS: The retrospective incidence-based cost of illness analysis was performed at the diabetes ward of 800-bed teaching hospital in Yangon, Myanmar. The data were retrieved from hospital financial reports and patient's medical records for the fiscal year 2017 to 2018. Data was analyzed by using descriptive statistics and multivariate statistics. One-way sensitivity analysis was used to assess the uncertainty of input parameters. RESULTS: This study involved 87 inpatients with type 2 diabetes mellitus with an average length of stay of 16.1 ± 12.6 days. Of the study sample, 67% had complications whereas 74% had comorbidities. The average treatment cost per admission was $718.7 (equal to 58% of gross domestic product - GDP per capita) at 2018 prices. Based on the multiple regression analysis, cost savings per admission were $276.5, $307.3, and $319.5 from preventing foot ulcer, nephropathy, and retinopathy, respectively. CONCLUSIONS: This study found that the treatment of diabetes is costly because of its preventable health consequences. Better disease management to prevent complications results in considerable cost savings. This quantitative evidence would increase awareness in health service system.

Cost-Effectiveness Analysis of Diagnostic Tests for Para-Aortic Lymph Node Detection in Locally Advanced Cervical Cancer.

PURPOSE: We aimed to determine the cost-effectiveness of diagnostic tests, ie, computed tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for para-aortic lymph node detection (PALND), in locally advanced cervical cancer (LACC) patients (stages IB3-IVA) with or without laparoscopic lymphadenectomy (LL) compared with no investigation (NoIx) based on provider and societal perspectives during 5 years. PATIENTS AND METHODS: Hybrid decision tree and Markov models were conducted to compare the cost and utility of six interventions including: 1) CT without LL, 2) CT with LL, 3) MRI without LL, 4) MRI with LL, 5) PET/CT without LL, and 6) PET/CT with LL compared with NoIx. All clinical parameters were obtained from published studies. Costs were presented in year 2019 values. Direct medical costs were retrieved from hospital database, while direct non-medical costs and utility were collected from interviewing 194 LACC patients during June to December 2019. One-way and probabilistic sensitivity analysis were used to investigate parameter uncertainties. RESULTS: Total costs of NoIx were $8026 and $11,444 from provider and societal perspectives, respectively, and quality-adjusted life year (QALY) was 3.70. NoIx was more effective and less costly. When six strategies were compared with NoIx, more additional costs were shown with $1835, $1735, $2022, $1987, $4002, and $4176 for CT without LL, CT with LL, MRI without LL, MRI with LL, PET/CT without LL, and PET/CT with LL, whereas QALYs were decreased with 0.07, 0.08, 0.07, 0.08, 0.05, and 0.07, respectively. Sensitivity analyses strengthened the benefit of NoIx. The most significant parameter was treatment outcomes of patients with PALN metastasis. CONCLUSION: NoIx or receiving basic clinical staging was a dominant option when compared with CT, MRI, and PET/CT for PALND before providing the treatment for LACC patients.

Cost of premature mortality attributable to smoking in the Middle East and North Africa.

BACKGROUND: Tobacco smoking is a leading cause of premature mortality, incurring substantial economic costs. AIMS: To estimate the rate and cost of premature mortality attributable to smoking in the 24 Middle East and North Africa (MENA) countries in 2015. METHODS: Smoking attributable fractions were estimated. Twenty-four smoking-related diseases were included in the analysis. For each country, the total number of deaths by disease, age, and gender among individuals aged ≥ 15 years were derived from a World Health Organization database. Human capital approach was used in calculating cost of premature mortality. RESULTS: Smoking was responsible for 465 285 deaths in MENA countries, resulting in 7 122 706 years of potential life lost, or an average of 15.23 years lost per smoking-related death. Of the total 465 285 smoking-related deaths, 412 415 (88.6%) occurred in men, accounting for 37% of all deaths from the diseases considered in this analysis among men. The total mortality cost attributable to smoking was estimated at US$ 29.7 billion in 2015 (0.76% of MENA's gross domestic product). Turkey was the country most affected by the tobacco epidemic, representing 41% of smoking-related mortality cost in the whole region, followed by Saudi Arabia (8.76%) and Egypt (7.88%). CONCLUSION: Smoking is an important preventable cause of premature mortality in MENA countries. Substantial decline in smoking-attributable deaths and significant economic cost saving can be achieved in this region through more effective tobacco control policies.

The Cost of Locally Advanced Cervical Cancer in Thailand: an Empirical Study for Economic Analysis.

OBJECTIVE: To evaluate cost of illness of locally advanced cervical cancer patients from societal perspective in three scenarios including completely cured without severe late side effects (S1), completely cured with late grade 3-4 gastrointestinal side effects (S2.1) or genitourinary side effects (S2.2), and disease recurrence and death (S3). METHODS:  The incidence-based approach was conducted. The cost was calculated for 5-year time horizon starting for the treatment initiation. Direct medical costs were extracted from hospital database. Cost of using two-dimensional technique and three-dimensional conformal radiation therapy were calculated separately. Direct non-medical costs and indirect costs in terms of productivity loss were based on actual expenses from the interview of 194 locally advanced cervical cancer patients from two tertiary hospitals in Bangkok, during June to December 2019. All costs were converted to US dollar in 2019 values. RESULTS: For 5 years, cost of illness per patient for using two-dimensional technique and three-dimensional conformal radiation therapy were US $8,391 and US $10,418 for S1, US $18,018 and US $20,045 for S2.1, US $17,908 and US $19,936 for S2.2, and US $61,076 and US $63,103 for S3, respectively. The economic burden for newly diagnosed locally advanced cervical cancer patients in Thailand in 2018 was approximately US $129 million and US $131 million for using two-dimensional technique and three-dimensional conformal radiation therapy, respectively. Cost from S3 accounted for 70% of all total cost. Premature death was the most important cost driver of cost of illness accounted for 64 % of the total cost estimates. CONCLUSIONS: Cost of illness of locally advanced cervical cancer patients produced significant economic burden from societal perspective. Disease recurrence and early death from cancer was the most influential cause of this burden.

Cost-Effectiveness Analysis of Community Case Management of Childhood Diarrhea in Burundi.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness of community case management (CCM) program of childhood diarrhea by providing oral rehydration salts and zinc through community health workers in Burundi. METHODS: A cost-effectiveness analysis study using a Markov modeling approach was undertaken to assess the CCM program of diarrhea from both provider and societal perspectives. The CCM program was compared with the routine management of childhood diarrhea at health facilities. Primary data on the cost of childhood diarrhea management were collected. Both economic and health outcomes were assessed for a period of 5 years, and a discount rate of 3% was applied. One-way and probabilistic sensitivity analyses were performed. RESULTS: The CCM program was found to be both less costly and more effective resulting to a negative value of incremental cost-effectiveness ratios, indicating that the program was dominant producing cost savings. Compared with the routine treatment of diarrhea at health facilities, the CCM program would avert 2749 additional disability-adjusted life years over a period of 5 years. The economic burden was reduced of US$1 056 699 and US$2 328 531 from the provider and societal perspectives, respectively. The cost-effectiveness estimates were mostly sensitive to the discount rate and the cost of outpatient visits at health facilities. The intervention remained dominant with a 100% probability of cost savings within 10 000 simulations of the sensitivity analysis. CONCLUSIONS: Providing inexpensive diarrheal treatment (oral rehydration salts and zinc) in communities is an attractive cost-effective intervention. Evidence from this study should be used to scale up the coverage of this life- and cost-saving intervention.

Economic evaluation of rotavirus vaccination: an important step of the introduction to the national immunization program in Thailand.

INTRODUCTION: World Health Organization recommends rotavirus vaccine for all national immunization programs (NIPs). To provide country-specific evidence, we conducted economic evaluation of a monovalent rotavirus vaccination using specific data of the pilot phase in Thailand. METHOD: A Markov model was adopted to compare the 2020 birth cohort once receiving rotavirus vaccination versus no vaccination from healthcare and societal perspective over five years. Data on disease burden, vaccine effectiveness, costs, and utilities were taken from a cohort study in two provinces of Thailand.  Sensitivity analyses were performed to test the robustness of the results. RESULTS: Rotavirus vaccination would reduce rotavirus diarrhea and costs of illness by 48% and 71%, respectively, over the first five years of life. At USD 13 per dose, vaccine was cost-effective with the ICERs of USD 4,114 and USD 1,571per QALY gained from healthcare and societal perspective, respectively. Results were sensitive to incidence and vaccine cost.  The budget for vaccine purchasing was estimated at USD13 million per year. CONCLUSION: Incorporating rotavirus vaccination into the NIP substantially reduced health and cost outcomes and was cost-effective for both perspectives. However, the government needs to negotiate vaccine price prior to program implementation to achieve favorable budget impact.

Economic burden of childhood diarrhea in Burundi.

BACKGROUND: In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. METHODS: The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. RESULTS: One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. CONCLUSION: Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.

Economic analysis for national immunization program planning: A case of rotavirus vaccines in Burundi.

BACKGROUND: In Burundi, diarrhea is the third leading cause of mortality among children under five years of age. This study conducted an economic analysis of rotavirus vaccination program in Burundi. METHODS: A Markov model was constructed to simulate clinical and economic outcomes for the 2019 birth cohort for a period of 5 years. Empirical costing data were collected. ICER per episode averted, ICER per death averted, ICER per DALY averted, net present value, and budget impact were estimated for 4 brands of WHO pre-qualified rotavirus vaccines. One-way and probabilistic sensitivity analysis as well as threshold analysis were performed. RESULTS: For the base case, while all four WHO pre-qualified rotavirus vaccines were cost-effective (ICER < 3 GDP per capita), three of them (i.e. Rotarix, Rotavac and Rotasiil) were very cost-effective (ICER <1 GDP per capita) from both the provider and societal perspectives. The vaccines were still very cost-effective at a price increase of up to US$ 5.09, US$ 3.16, US$ 3.89, and US$ 2.69 for Rotarix, RotaTeq, Rotavac, and Rotasiil, respectively. Probabilistic sensitivity analysis indicated that vaccination programs with Rotarix, RotaTeq, Rotavac, and Rotasiil are cost-effective at a probability of 93.8%, 27%, 99.1%, and 92.7%, respectively. All vaccination programs were cost-beneficial with a net present value in the range of US$ 5,214,912 and US$ 11,135,997.The budget required to run the vaccination program, estimated with break-even prices, ranged between US$ 42,249,498 and US$ 53,487,935 for a 5-year time period. When compared to the GDP of Burundi in 2019, these are are less than 2%. CONCLUSION: The rotavirus vaccine is good value for money. Findings from this study offer evidence on potential economic benefits as well as the required budget for different rotavirus vaccination programs, which could be useful for future planning related to rotavirus vaccine coverage in Burundi after graduation from GAVI.

Treatment cost and costing model of obstetric complications at a hospital in Myanmar.

Maternal health still remains a major challenge in almost all developing countries. In Myanmar, the country met only 62% of its target for the maternal mortality rate (130 per 100,000 live birth) even though proportion of skilled birth attendant (SBA) and antenatal care (ANC) coverage was 80% in 2015. Despite the estimated large maternal complications, most maternal healthcare program ignored the burden of those morbidity because of limited understanding of the incidence and prevalence of morbidity conditions and cost of those morbidity burdens on society. The present study provides a general idea of the scope of obstetric complication, incidence of obstetric complication, and cost of those morbidity burdens on society. We conducted a retrospective incidence-based cost of illness study related to obstetric complication from the healthcare system perspective at 25 bedded township hospital in Yedashae during the fiscal year of 2015-2016. For the cost of obstetric complication, average treatment cost was 26.83 USD (±8.59). When looking by disease category, average treatment cost for incomplete abortion was 35.45 USD (±1.75); pelvic inflammatory disease (PID) was 16.01 USD; pregnancy-induced hypertension (PIH) was 21.02 USD (±4.68); ante-partum hemorrhage (APH) was 14.24(± 0.25); post-partum hemorrhage (PPH) was 27.04 USD (±1.56); prolonged labor was 37.55 USD (±0.42); and septicemia was 16.51 USD (±2.15). Significant predicting variables in obstetric complication cost model were incomplete abortion, prolonged labor, post-partum hemorrhage (PPH), pregnancy induced hypertension (PIH), patient age and septicemia. From this study, we can summarize the most frequently occurred obstetric complication in that township area, actual cost burden of those complications and obstetric complication cost model which can be useful for hospital financial management. This study can be considered as a starting point for cost of illness analysis in Myanmar to prioritize and target specific health problem at a country level for policy maker to set priorities for health care intervention.

Excess annual economic burdens from nosocomial infections caused by multi-drug resistant bacteria in Thailand.

Background - Antimicrobial resistance (AMR) is a major health threat worldwide as it brings about poorer outcomes and places economic burdens to society. This study aims to estimate the economic burdens from nosocomial infections (NI) caused by multi-drug resistant (MDR) bacteria in Thailand. Research design and methods - A retrospective cohort study was conducted at a tertiary hospital over 2011-2012. A multivariate log-linear regression model was used to estimate the excess treatment costs of AMR to those non-AMR patients. Results - Switching from a non-AMR case to an AMR infection case, resulted in 42% increase in expected average treatment costs per patient. The annual treatment from hospital perspective and antibiotic costs associated with the management of AMR infections were estimated to be US$ 2.3 billion and US$ 262 million, respectively. The estimated annual benefit from eradicating AMR NI were US$ 4.2 billion from a societal perspective with the annual gains in quality-adjusted life years (QALYs) of 0.6 million due to the absence of 111,295 AMR cases each year. Conclusions - Large amount of money was spent on treatment and antibiotic costs to manage AMR infections. Benefit of eliminating these infections was estimated and it would be highly cost-effective.

Economic burden of rotavirus diarrhea in Thailand: Report from a pilot study on rotavirus vaccination.

BACKGROUND: Rotavirus diarrhea is the leading cause of morbidity and mortality in young children in both developed and developing countries. Hospitalization costs are a significant burden of both governments and households. The objective of this study was to estimate the economic burden associated with the hospitalization of children with non-rotavirus and rotavirus diarrhea in two provinces in Thailand. METHOD: A prospective incidence-based cost-of-illness study was conducted on children under five years old with acute diarrhea who had been admitted to public hospitals in two provinces during October 2012 and June 2013. Caregivers were interviewed to estimate costs from a societal perspective at 2014 values. Stool samples were examined for rotavirus antigens. Multivariate regression analysis was used to assess the relationship of predictor variables to costs. Annual economic burden of rotavirus hospitalization was estimated by multiplying the number of hospitalized children and the hospitalization cost per episode. The costs were converted to international dollars (I$) using purchasing power parity (PPP) (1 USD = 12.36 baht for the year 2014). RESULTS: Seven hundred and eighty-eight cases of acute diarrhea were included in the analysis. Of the total, one hundred and ninety-seven (25%) were detected as being rotavirus positive. Total societal costs of inpatient care per episode were 822.68 USD (10,165 Baht). The average costs of children with and without rotavirus were 903.39 USD (11,162 Baht) and 795.40 USD (9,827 Baht), respectively. Based on the multiple regression analysis, rotavirus infection, severity, and younger age were significantly associated with the higher costs. CONCLUSION: Diarrhea, rotavirus diarrhea in particular, represents of a substantial economic burden in the society in Thailand. The accurate estimates that societal costs of the rotavirus diarrhea hospitalizations provide valuable input for considering a preventive program.

COST-UTILITY ANALYSIS OF MULTIPLE SCLEROSIS TREATMENT IN THAILAND.

OBJECTIVES: Although interferon beta-1a (IFNß-1a), 1b (IFNß-1b), and fingolimod have been approved as multiple sclerosis (MS) treatments, they have not yet been included on the National List of Essential Medicines (NLEM) formulary in Thailand. This study aimed to evaluate the cost-utility of MS treatments compared with best supportive care (BSC) based on a societal perspective in Thailand. METHODS: A Markov model with cost and health outcomes over a lifetime horizon with a 1-month cycle length was conducted for relapsing-remitting MS (RRMS) patients. Cost and outcome data were obtained from published studies, collected from major MS clinics in Thailand and a discount rate of 3 percent was applied. The incremental cost-effectiveness ratio (ICER) was calculated and univariate and probabilistic sensitivity analyses were performed. RESULTS: When compared with BSC, the ICERs for patients with RRMS aged 35 years receiving fingolimod, IFNß-1b, and IFNß-1a were 33,000, 12,000, and 42,000 US dollars (USD) per quality-adjusted life-year (QALY) gained, respectively. At the Thai societal willingness to pay (WTP) threshold of USD 4,500 per QALY gained, BSC had the highest probability of being cost-effective (49 percent), whereas IFNß-1b and fingolimod treatments showed lower chance being cost-effective at 25 percent and 18 percent, respectively. CONCLUSIONS: Compared with fingolimod and interferon treatments, BSC remains to be the most cost-effective treatment for RRMS in Thailand based on a WTP threshold of USD 4,500 per QALY gained. The results do not support the inclusion of fingolimod or interferon in the NLEM for the treatment of RRMS unless their prices are decreased or special schema arranged.

Estimating the economic impact of canine rabies to Viet Nam 2005-2014.

The global economic impact of canine rabies has been estimated by several studies. Asia bears a disproportionate burden of this zoonosis due to high levels of human deaths and rates of post-exposure prophylaxis (PEP), but low investment in preventative dog vaccination. The same factors that cause rabies to burden much of Asia are also present in Viet Nam. This study estimated the economic burden of canine rabies in a societal perspective including direct and indirect cost of rabies in dogs, livestock, and humans. Using data collected from personal interviews, published literature, published and supplementary reports, and primary data collection, we estimated the economic impact of canine rabies in Viet Nam over a ten year period (2005-2014). We incorporated the direct and indirect costs for PEP, dog vaccination efforts, livestock losses, and disability adjusted life years (DALYs) into the analysis. General findings from this analysis indicated that over the 10 year study period, the total economic impact of canine rabies was over $719 million USD. The largest portion of impacts (92%) were made up of PEP-related costs. Canine rabies created between 36,560 and 45,700 DALYs, measured in years of life lost (YLL). A total of 914 human deaths were reported over the study period. Deaths/100,000 people were 0.11, which is lower than the reported level for Asian countries. The cost per dog vaccinated was $1.75 USD. Our results indicate that canine rabies impacts in Viet Nam are consistent with the burden elsewhere reported in Asia, with large expenditures on PEP and very small investments in dog vaccination.