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2.
BMC Public Health ; 19(1): 1399, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660928

RESUMO

BACKGROUND: Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital. METHOD: An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI. RESULTS: The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001). CONCLUSION: Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Traumatismos Craniocerebrais/economia , Hospitais Universitários/economia , Encaminhamento e Consulta/economia , Adolescente , Adulto , Criança , Pré-Escolar , Traumatismos Craniocerebrais/terapia , Estudos Transversais , Etiópia , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
3.
BMC Public Health ; 19(1): 1031, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370810

RESUMO

BACKGROUND: In Mozambique cervical cancer is a public health threat, due to its high incidence and limited access to early diagnosis of precancerous lesions. International organisations are supporting the introduction of human papillomavirus (HPV) vaccines in low- and middle-income countries. Some of these countries recently conducted demonstration programmes, which included evaluation of acceptability, coverage, and practicality of implementation and of integration in existing programmes. Information on costs of delivering the vaccine is needed to overcome the challenges of reaching vaccine potential recipients in rural and remote areas. METHODS: We estimated the financial and economic costs of delivering HPV vaccination to ten-year-old girls at schools for the first vaccination cycle of the demonstration programme in the Manhiça district (southern Mozambique), delivered throughout 2014. We also estimated costs of an alternative scenario with a reduced number of doses and personnel, which was analogous to the second vaccination cycle delivered throughout 2015. Cost estimates followed a micro-costing approach and included interviews with key informants at different administrative levels through the administration of standard questionnaires developed by the World Health Organisation. RESULTS: Considering only data from the first vaccination cycle (2014), which consisted in the administration of three doses, the average economic cost was US$17.59 per dose and US$52.29 per fully-immunised girl (FIG). Financial cost per dose (US$6.07) and per FIG (US$17.95) were substantially lower. The economic cost was US$15.53 per dose and US$31.14 per FIG when estimating an alternative cost scenario with reduced number of doses and personnel. CONCLUSIONS: The average economic cost per dose was lower than the ones recently reported for low- and middle-income countries. However, our estimation of the financial cost per FIG was higher than the ones observed elsewhere (ranging from US$2.49 in India to US$20.36 in Vietnam) due to the high percentage of out-of-school girls which, reduced vaccine coverage and, therefore, reduced the denominator. Due to budget constraints, if Mozambique is to implement nation-wide HPV vaccination targeted to ten-year-old girls at schools, a reduction in personnel costs should be operated either by restricting the outreach vaccinator team or the number of supervision visits.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Programas de Imunização/economia , Vacinas contra Papillomavirus/economia , Serviços de Saúde Escolar/economia , Criança , Feminino , Humanos , Moçambique , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/prevenção & controle
4.
Artigo em Inglês | MEDLINE | ID: mdl-31323981

RESUMO

Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003-2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003-2008. This was followed by a 30% increase during 2008-2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010-2013 but decreased during 2013-2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time.


Assuntos
Comércio/economia , Comportamento do Consumidor/economia , Custos e Análise de Custo/economia , Renda/estatística & dados numéricos , Fumantes/psicologia , Impostos/economia , Produtos do Tabaco/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , Inquéritos e Questionários , Impostos/estatística & dados numéricos , Tabaco , Produtos do Tabaco/estatística & dados numéricos , Estados Unidos , Adulto Jovem
5.
BMC Public Health ; 19(1): 940, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299939

RESUMO

BACKGROUND: Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities. METHODS: This is a cross-sectional study nested on an ongoing longitudinal study in South Africa. Two communities (a rural and urban) of low socio-economic status were purposely selected from two of the nine provinces. A sample of 535 participants aged 30-75 years was randomly selected from the longitudinal cohort of 1220; 411 (78%) women. Data were collected using validated food frequency and structured interviewer-administered questionnaires. Descriptive and multivariate regression analysis were undertaken. RESULTS: A higher proportion of participants in the urban township compared to their rural community counterparts had purchased fruits (93% vs. 51%) and vegetables (62% vs. 56%) either daily or weekly. Only 37.8% of the participants consumed at least two portions of commonly available fruits and vegetables daily, with no differences in the two communities. Daily/weekly purchase of sugar sweetened beverages (SSBs) was associated with daily intake of fruits and vegetables (p = 0.014). Controlling for age and gender, analysis showed that those who spent R1000 (USD71.4) and more on groceries monthly compared to those who spent less, and those who travelled with a personal vehicle to purchase groceries (compared to those who took public transport) were respectively 1.6 times (AOR, 95% CI: 1.05-2.44; p = 0.030) and 2.1 times (AOR, 95% CI: 1.06-4.09; p = 0.003) more likely to consume at least two or more portions of fruits and vegetables daily. Those who purchased SSBs daily or weekly were less likely (AOR, 95% CI: 0.54, 0.36-0.81, p = 0.007) to consume two or more portions of fruits and vegetables daily. The average household monthly income was very low (only 2.6% of households earned R5000 (US$357.1); and education level, attitude towards fruits and vegetables and owning a refrigerator had no significant association with fruits and vegetable daily intake. CONCLUSION: These findings indicate that affordability and frequency of purchase of sugary drinks can influence daily intake of fruits and vegetables in resource-limited communities.


Assuntos
Dieta/estatística & dados numéricos , Frutas , Áreas de Pobreza , Verduras , Adulto , Idoso , Bebidas , Custos e Análise de Custo/estatística & dados numéricos , Açúcares da Dieta/administração & dosagem , Feminino , Frutas/economia , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul , Verduras/economia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31248213

RESUMO

To reduce groundwater overexploitation and alleviate water shortages, market mechanisms are introduced to allocate water rights. Scientific and reasonable pricing of groundwater rights is key to ensuring the effectiveness of the groundwater market. Because of the complexity and uncertainty of water resources, this study calculates the price of groundwater rights based on the value of water resources with an evaluation indicator system. The system includes 14 indicators developed with a fuzzy mathematics model addressing three dimensions: environment, society, and economy. The weights of the indicators are determined through the analytic network process (ANP) and the entropy method. The results show that the price of groundwater rights in Ningxia, China increased from 5.11 yuan/m3 to 5.73 yuan/m3 between 2013 and 2017; this means the price was basically stable, with a slight increase. The ratio of residents' water fee expenditures to real disposable income also remained essentially stable, fluctuating around 0.37%, far below the normal level. These data demonstrated that the current regional water price policy does not reflect the true value of groundwater resources; there is room to increase urban water prices. Local governments need speed up water price system reforms and adopt water rights systems to optimize water resource allocations.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Água Subterrânea , Propriedade/economia , Recursos Hídricos/provisão & distribução , China , Modelos Teóricos
7.
Public Health ; 171: 116-122, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31125867

RESUMO

OBJECTIVES: Housing is one of the social determinants of health, and the evidence of its impact in this area has been increasingly expanded. However, in spite of its importance, there have been few studies to investigate an association between housing and health in Korea. Our study aimed to investigate housing tenure and affordability and their effects on health outcomes in Korea. STUDY DESIGN: We selected 9456 participants from the 10-11th wave of the Korea Welfare Panel Study, after excluding missing variables. Housing tenure and affordability were chosen as independent variables, and depressive symptoms and self-rated health were selected as dependent variables. METHODS: Logistic regression was implemented to investigate the association between housing tenure/affordability and health outcome, and all covariates such as sex, age, and household income were adjusted. RESULTS: Compared with homeowners, renters are more likely to have depressive symptoms (odds ratio [OR]: 1.26, 95% confidence interval [CI]: 1.08, 1.47) and poor self-rated health (OR: 1.38, 95% CI: 1.19-1.61). Also, health effects of housing unaffordability were observed differently by tenure, showing that the likelihood of having depressive symptoms (OR: 1.56, 95% CI: 1.15, 2.13) and poor self-rated health (OR: 1.51, 95% CI: 1.10, 2.06) is significantly high among renters who reported unaffordability. CONCLUSION: This study could provide evidence of housing as a determinant of health by showing that both housing tenure and affordability are significantly related to health outcomes.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Depressão/epidemiologia , Habitação/economia , Habitação/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Adulto , Autoavaliação Diagnóstica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Determinantes Sociais da Saúde
8.
Lupus ; 28(7): 799-805, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042129

RESUMO

Cutaneous lupus erythematosus (CLE)-a common presentation of lupus erythematosus-may exist independently or as a part of the systemic manifestations of systemic lupus erythematosus. The effects of living with and treating a chronic condition such as CLE can be debilitating to a patient's health and finances. The management of patients with CLE is made particularly challenging by poor compliance, limited therapeutic options, scarcity of evidence supporting their use, and significant differences in costs of medications. Effective management of CLE should center on prevention, individualized treatment regimens, and a mutual understanding of the challenges that patients with CLE face. This article seeks to provide an overview of the efficacy, safety, and cost of therapeutic options for CLE.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Lúpus Eritematoso Cutâneo/economia , Lúpus Eritematoso Cutâneo/terapia , Administração Tópica , Antimaláricos/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Efeitos Psicossociais da Doença , Medicina Baseada em Evidências , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Esteroides/administração & dosagem
9.
J Wound Care ; 28(5): 261-266, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31067160

RESUMO

OBJECTIVE: To evaluate the methodological approaches used to assess the cost consequences of diabetic foot ulcers (DFUs) in published scientific papers. METHOD: A systematic literature search was conducted in PubMed, Embase, Scopus, Web of Science and CINAHL. English language papers reporting on the cost of DFUs were identified. Additionally, bibliographies were inspected to identify other relevant cost studies. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective and data collection approach in each of the included studies. RESULTS: Relatively few studies of the cost consequences of DFUs were found (n=27). Most studies were conducted in Western countries with only five studies from countries in Asia and Africa. The identified studies used different study designs, epidemiological approaches, data collection strategies, and data sources, which in turn made a systematic comparison of cost estimates difficult. Detailed descriptions of the applied costing method and other methodological aspects were often limited or absent. Many studies only reported costs from a health-care payer's perspective and disregarded the costs to patients, their families and wider society. CONCLUSION: The costs of DFUs have been assessed using a wide range of different methodological approaches often restricted to the healthcare payer's perspective. Therefore, the cost analyses may fail to consider the true societal costs of DFUs.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Complicações do Diabetes/economia , Complicações do Diabetes/terapia , Pé Diabético/economia , Pé Diabético/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Public Health ; 170: 113-121, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30991173

RESUMO

OBJECTIVES: Antenatal care (ANC) during pregnancy and skilled birth attendance (SBA) during delivery are important policy concerns to reduce maternal deaths. Bangladesh is one of the developing countries which has made remarkable progress in both services during the last couple of decades by improving the SBA service rate from 16% in 2004 to 42.1% in 2014. However, this rate remains below the targeted level (50%) of the Health Population and Nutrition Sector Development Program set by the Ministry of the Health and Family Welfare of Bangladesh. This article explored the sociodemographic factors associated with the ANC and SBA service attainment. Furthermore, the possible implication of using ANC on SBA was also investigated. STUDY DESIGN: The study followed a cross-sectional design using the Bangladesh demographic and health survey 2014, with a sample of size 4603 women with at least one live birth 3 years preceding the survey. METHODS: Following a bivariate analysis, linear mixed-effect models were used to assess the relationship between sociodemographic factors and the outcome indicators (ANC and SBA). Finally, the association between SBA and ANC was evaluated through another mixed-effect model. RESULTS: Wealth index, participation in household decisions, and partner's and respondent's education were significant predictors of ANC; whereas, residence, age at first birth, wealth index, working status, participation in household decisions, and partner and respondent's education were significant for SBA. Female education and household affordability were the strongest predictors for both ANC and SBA. ANC showed significant association with SBA as women accessing essential ANC during delivery seemed to be 4 times more likely (95% confidence interval: 3.05-5.93) to avail SBA services. CONCLUSIONS: Overall, four factors were significant: residence, wealth index, education, and ANC access. Women residing in urban areas, having higher financial solvency, completing higher education, and accessing ANC by skilled personnel were more likely to receive SBA at delivery than their counterparts. Accessibility to skilled care during pregnancy leads to increased professional care during delivery. Thus, policies to encourage women and heads of families to seek skilled care during pregnancy would be beneficial to reach the maternal healthcare targets of Bangladesh.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Escolaridade , Família , Tocologia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Bangladesh , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Tocologia/economia , Gravidez , Cuidado Pré-Natal/economia , Fatores Socioeconômicos , Adulto Jovem
11.
Scand J Rheumatol ; 48(4): 300-307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30836033

RESUMO

Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.


Assuntos
Artrite Juvenil , Artrite Psoriásica , Artrite Reumatoide , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Espondilartrite , Adulto , Artrite Juvenil/economia , Artrite Juvenil/epidemiologia , Artrite Psoriásica/economia , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/economia , Artrite Reumatoide/epidemiologia , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Espondilartrite/economia , Espondilartrite/epidemiologia
12.
Prev Vet Med ; 165: 63-70, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30851929

RESUMO

This paper addresses whether it is worthwhile investing time in a more comprehensive documentation and analysis of farm specific data for mastitis treatment. Whilst most farmers keep some records, many refrain from investing more effort in making them more detailed. Therefore, information on farm-specific antibiotic consumption, effectiveness of treatments and the costs of mastitis are lacking; as well as the ability to identify and realise possibilities for improvement. An observational study was conducted on 30 dairy farms, to obtain an overview of farming practice, recording detailed data (using herd management software) on: milk records, diagnostics, preventive and therapeutic treatments and cost of mastitis, on an individual cow level. Out of a total of 30,633 cows, 67% received medication for the treatment or prevention of mastitis over a year. Antibiotics were chosen for 96% of udder treatments; including those for dry cows. Over 32% of the antibiotics used during lactation belonged to the 'highest priority critically important antimicrobial' category. Success of therapeutic treatment (assessed by individual somatic cell count (SCC)) ranged from 18% to 59% and total costs of mastitis per cow and year from € 158 to € 483. The high variations in antibiotic consumption, treatment outcomes and cost of mastitis between farms, showed that average or incomplete figures risk giving the wrong impression of a farm. It is thus worthwhile to invest in documentation and analysis of data, so that it is clear where action is required and which investments can be expected to be financially feasible. Benefits emerge from knowledge of antibiotic consumption allowing monitoring and reduction in antibiotic use (as demanded by consumers and legislation), improvements in animal health and welfare thanks to regular checks of how effective a treatment is, and economic benefits due to knowledge of the costs caused by mastitis.


Assuntos
Antibacterianos/economia , Indústria de Laticínios/economia , Mastite Bovina/economia , Animais , Antibacterianos/uso terapêutico , Bovinos , Contagem de Células , Custos e Análise de Custo/estatística & dados numéricos , Indústria de Laticínios/métodos , Indústria de Laticínios/estatística & dados numéricos , Feminino , Mastite Bovina/tratamento farmacológico , Leite/economia , Leite/microbiologia , Resultado do Tratamento
13.
PLoS One ; 14(3): e0213745, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870475

RESUMO

PURPOSE: Safety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to conduct a budgetary impact analysis of a multidisciplinary primary care-based HCV treatment program, with and without 340B support. METHODS: We conducted a budgetary impact analysis from the perspective of a large safety-net medical center in Boston, Massachusetts. Participants included 302 HCV-infected patients (mean age 45, 75% male, 53% white, 77% Medicaid) referred to the primary care-based HCV treatment program from 2015-2016. Main measures included costs and revenues associated with the treatment program. Our main outcomes were net cost with and without 340B Drug Pricing support. RESULTS: Total program costs were $942,770, while revenues totaled $1.2 million. With the 340B Drug Pricing Program the hospital received a net revenue of $930 per patient referred to the HCV treatment program. In the absence of the 340B program, the hospital would lose $370 per patient referred. Ninety-seven percent (68/70) of patients who initiated treatment in the program achieved a sustained virologic response (SVR) at a net cost of $4,150 each, among this patient subset. CONCLUSIONS: The 340B Drug Pricing Program enabled a safety-net hospital to deliver effective primary care-based HCV treatment using a multidisciplinary care team. Efforts to sustain the 340B program could enable dissemination of similar HCV treatment models elsewhere.


Assuntos
Orçamentos/normas , Custos e Análise de Custo/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Hepatite C/economia , Medicamentos sob Prescrição/economia , Atenção Primária à Saúde/estatística & dados numéricos , Provedores de Redes de Segurança/organização & administração , Custos de Medicamentos/legislação & jurisprudência , Feminino , Programas Governamentais , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Provedores de Redes de Segurança/economia , Estados Unidos
14.
PLoS One ; 14(2): e0212125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753219

RESUMO

INTRODUCTION: The Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a payment policy in other areas of health care, it is important to investigate the prices, affordability and availability of essential medicines in Malawi. METHODS: Data on availability and prices of 50 essential medicines were collected in 44 health facilities in two major cities and two districts. These included 12 public facilities, 11 facilities of the Christian Health Association of Malawi (CHAM), nine retail pharmacies, eight wholesalers and four private clinics/hospitals. Price, availability and affordability were assessed based on the methodology developed by the World Health Organization and Health Action International, which compares local prices to international reference prices. RESULTS AND DISCUSSION: The overall availability of medicines was 48.5% in public facilities, 71.1% in retail pharmacies, 62.9% in CHAM facilities and 57.5% in private clinics. The availability of essential medicines varied from 0% for ethosuximide to 100% for amoxicillin and cotrimoxazole tablets. Antibiotic formulations for adults were widely available, in contrast to the low availability of pediatric formulations. Several medicines for non-communicable diseases like sodium valproate, phenytoin, paraldehyde, captopril and simvastatin showed poor availability and affordability. The overall median price ratio compared to the international reference price was 1.11 for wholesalers, 2.54 in CHAM facilities, 2.70 in retail pharmacies, and 4.01 in private clinics, which is low compared to other countries. But nevertheless, for 18 out of 32 medicines assessed, the cost of one course exceeded the statutory minimum daily wage, making them unaffordable to a majority of the population. Therefore, continued provision of free public health care is still of critical importance for the foreseeable future until other financing mechanisms have been explored.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Comércio/estatística & dados numéricos , Estudos Transversais , Malaui
16.
Eur J Contracept Reprod Health Care ; 24(1): 24-29, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30730214

RESUMO

OBJECTIVES: To evaluate the effect of the cost of subdermal etonogestrel implant (SEI) on the continuation rate one year after insertion, and to assess the reasons given by users to remove the implant before the expiration date. METHODS: Prospective cohort study conducted among 265 women who chose the SEI as a contraceptive method in a sexual and reproductive health center in the eastern region of Spain, between October/2012 and October/2017. The sample was divided into two cohorts depending on the cost of the implant for the user (free-of-charge or requiring partial payment). Kaplan-Meier survival curves were used to compare the cumulative removal rates of free implants with partially paid implants within the first year of insertion. Cox proportional hazards models were used to control for confounders. RESULTS: After adjusting for confounders, no significant associations were found between the cost of the implant and its removal within a year of insertion. No significant associations were found in the reasons given for implant removal and for the duration of implant use. CONCLUSIONS: Cost was not associated with SEI continuation rates within the first year of use. No other significant variables were found to explain implant removal within one year of use.


Assuntos
Anticoncepção/economia , Custos e Análise de Custo/estatística & dados numéricos , Remoção de Dispositivo/economia , Dispositivos Intrauterinos/economia , Adulto , Anticoncepção/métodos , Feminino , Humanos , Estudos Prospectivos , Espanha , Fatores de Tempo
17.
PLoS One ; 14(1): e0210517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682042

RESUMO

At the time of this study, prior to the introduction of biologics in the US, systemic therapies used for the treatment of moderate-to-severe atopic dermatitis included off-label immunosuppressants and corticosteroids. Immunosuppressant therapy is associated with a substantial risk of side-effects, therefore needing clinical monitoring, and is likely to incur a significant healthcare burden for patients and payers. This retrospective cohort study based on claims data measured immunosuppressant use and its associated burden among US adult patients with atopic dermatitis covered under commercial or Medicare Supplemental insurance from January 01, 2010, to September 30, 2015. Overall, based on age, gender, region, and index year, 4201 control patients with atopic dermatitis without immunosuppressant use were matched with 4204 patients treated with immunosuppressants. The majority (68.5%) of patients using immunosuppressants were non-persistent with immunosuppressant treatment during the 12-month follow-up period after a mean (standard deviation) of 88.1 (70.7) days of immunosuppressant use; 72.3% required systemic steroid rescue treatment. Immunosuppressant users had higher incidence of immunosuppressant-related clinical events than controls; in addition, a larger proportion of immunosuppressant users versus controls developed cancer (0.28% vs 0.14%, respectively; P < 0.0001). Healthcare utilization and costs associated with clinical events and monitoring were also higher for immunosuppressant users compared with controls (total costs, $9516 vs $1630, respectively; P < 0.0001; monitoring costs, $363 vs $54, respectively; P < 0.0001). This study revealed that patients treated with systemic immunosuppressants often require systemic steroids or changes to treatment. The increase in immunosuppressant-related clinical events, including the need for increased monitoring with immunosuppressant treatment, compared with controls demonstrates a substantial treatment burden and highlights the unmet need for more effective long-term therapies for atopic dermatitis with improved safety profiles and reduced monitoring requirements.


Assuntos
Corticosteroides/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Imunossupressores/uso terapêutico , Revisão da Utilização de Seguros/economia , Adulto , Idoso , Custos e Análise de Custo/economia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
18.
Artigo em Inglês | MEDLINE | ID: mdl-30609676

RESUMO

Objective: To examine the effects of increasing minimum wage on supermarket food prices in Seattle over 2 years of policy implementation, overall and differentially across food quality metrics. Methods: Prices for the UW Center for Public Health Nutrition (CPHN) market basket of 106 foods were obtained for 6 large supermarket chain stores in Seattle ("intervention") and for the same chain stores in King County ("control") at four time points: 1-month pre- (March 2015), 1-month post- (May 2015), 1-year post- (May 2016), and 2-years post-policy implementation (May 2017). Prices for all food items were standardized and converted to price per 100 kcal. Food quality metrics were used to explore potential differential price increases by (a) food groups, as defined by US Department of Agriculture; (b) NOVA food processing categories, and (c) nutrient density quartiles, based on the Nutrient Rich Foods Index 9.3. Separate difference-in-differences linear regression models with robust standard errors, examined price differences per 100 kcal overall, clustered by store chain, and stratified by each food quality metric. Results: There were no overall market basket price changes attributable to Seattle's minimum wage policy. Moreover, no minimum wage effect was detected by USDA food group, food processing, or nutrient density categories. Conclusions: Local area supermarket food prices were not impacted by Seattle's minimum wage policy 2 years into policy implementation and after the first increase to $15/h overall or by sub-classification. Low-income workers may be able to afford higher quality diets if wages increase yet supermarket prices stay the same.


Assuntos
Comércio/economia , Custos e Análise de Custo/economia , Qualidade dos Alimentos , Abastecimento de Alimentos/economia , Pobreza/economia , Salários e Benefícios/economia , Adulto , Cidades/estatística & dados numéricos , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Washington
19.
Tob Control ; 28(Suppl 1): s20-s30, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29674513

RESUMO

BACKGROUND: The price of tobacco products in relation to the income of tobacco users-affordability-is recognised as a key determinant of tobacco use behaviour. The effectiveness of a price increase as a deterrent to tobacco use depends on how much price increases in relation to the income of the potential users. The aim of this paper is to examine the distribution of and trends in the affordability of tobacco products in Bangladesh. METHOD: Using four waves of International Tobacco Control Survey data on Bangladesh, this study measures affordability of tobacco products at the individual level as the ratio of self-reported price and self-reported income. The trends in affordability by brand categories of cigarettes and of bidi and smokeless tobacco are estimated using multivariate linear regression analysis. RESULTS: Despite significant increase in price, the affordability of cigarettes increased between 2009 and 2014-2015 due to income growth outpacing price increase. The increase was disproportionately larger for more expensive brands. The affordability of bidis increased over this period as well. The affordability of smokeless tobacco products remained unchanged between 2011-2012 and 2014-2015. CONCLUSION: The tax increases that were implemented during 2009-2015 were not enough to increase tobacco product prices sufficiently to outweigh the effect of income growth, and to reduce tobacco consumption. The findings from this research inform policymakers that in countries experiencing rapid economic growth, significant tax increases are needed to counteract the effect of income growth, in order for the tax increases to be effective in reducing tobacco use.


Assuntos
Comércio/tendências , Custos e Análise de Custo/tendências , Renda/tendências , Produtos do Tabaco/economia , Adolescente , Adulto , Bangladesh , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Fatores Socioeconômicos , Adulto Jovem
20.
Trop Med Int Health ; 24(1): 43-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30307681

RESUMO

OBJECTIVE: To evaluate price, availability and affordability of insulin products in Shaanxi Province, western China. METHODS: We used a simplified and adapted WHO/Health Action International method to obtain the availability and prices of insulin products and five oral anti-diabetic medicines as comparators in public general hospitals and private retail outlets. In addition, we investigated the price components of eight selected insulin products by tracing the supply chain. RESULTS: All three kinds of insulin products, prandial, basal and premixed insulin, are 100% available in public hospitals, and have fairly high availability in the private sector (62.5-68.8%). The prices of most insulin products were higher than international reference prices in both sectors (ranging from 0.95 times to 2.33 times). All insulin products were unaffordable as they would cost 3.5-17.1 days' wage of the lowest-paid government workers in Shaanxi. The manufacturer's markup (selling price), which comprised more than 60% of the final price of all insulin products surveyed, was the largest price component. CONCLUSIONS: Although availability of insulin products was high in public general hospitals and private retail pharmacies, their high price made them unaffordable to diabetes patients, especially low-income patients. The government should increase insurance compensation for those who need these life-saving medicines or decrease the cost of insulin products through negotiation with suppliers.


Assuntos
Custos e Análise de Custo/economia , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Insulina/economia , Honorários por Prescrição de Medicamentos/estatística & dados numéricos , China , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/economia , Humanos , Insulina/provisão & distribução , Setor Público
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