Cost and budget impact analysis of a school-based vision screening programme in Cambodia and Ghana: implications for policy and programme scale-up

Background:Spondyloarthritis refers to a family of diseases, of which ankylosing spondylitis and non-radiographic axial spondyloarthritis are responsible for axial impairment. Previously, the only treatment available were NSAIDs, which control activity and stop radiological progression, but at the expense of increased adverse effects, such as cardiovascular risk, dyspepsia and chronic renal failure. For the past 2 decades, biological therapy has been available, which means an increase in care costs.Objectives:The objective of this study is to perform a budget impact analysis of biologic therapy.Methods:To do a budget impact analysis from the perspective of the payer, comparing biological therapy with coventional therapy for the treatment of spondyloarthritis. Demographic characterization of the population attended at the Central Military Hospital. Time horizon from 2012 to 2018, taking the activity count according to the hospital’s billing and the prices of the activities of the state body SISMED. Exchange rates at the end of 2018.Results:The patients attended were 117, mostly men (63, 25%), average age 46, 4 years (SD 13), with disease diagnosis time of 9, 8 years (SD 9, 6). In the budget impact analysis, it is observed that 25% of patients were on DMARDs therapy, 22% with NSAIDs and 96% with biologic therapy. The average year/patient cost with NSAIDs alone would be EUR 381, with DMARDs only EUR 9,318 and, if only biological therapy was used, EUR 423. Within the total number of patients, the average annual cost, including the possibility of combining these drugs, amounted to EUR 5,403Conclusion:Including biological therapy in the care of patients with spondyloarthritis can increase up to 24 times the annual cost per patient. This increase is not only due to higher market value, it also relates to the need for more medical procedures and diagnostic follow-up tests.References:[1]Strömbeck, et al. Cost of Illness from the Public Payers’ Perspective in Patients with Ankylosing Spondylitis in Rheumatological Care. J Rheumatol 2010;37;2348-2355.Disclosure of Interests:None declared

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School-based vision screening in Quetta, Pakistan: a qualitative study of experiences of teachers and eye care providers

BMC Public Health ◽

10.1186/s12889-021-10404-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stevens Bechange ◽

Munazza Gillani ◽

Emma Jolley ◽

Robina Iqbal ◽

Leena Ahmed ◽

...

Keyword(s):

Qualitative Study ◽

Screening Programme ◽

Public Health Problem ◽

Care Hospital ◽

Vision Screening ◽

Care Providers ◽

Eye Care ◽

Training Experience ◽

Screening Guidelines ◽

School Based

Abstract Background Visual impairment in children is a significant public health problem affecting millions of children globally. Many eye problems experienced by children can be easily diagnosed and treated. We conducted a qualitative study with teachers and optometrists involved in a school-based vision screening programme in Quetta district of Pakistan to explore their experiences of training, vision screening and referrals and to identify factors impacting on the effectiveness of the programme. Methods Between April 2018 and June 2018, we conducted semi-structured in-depth interviews with 14 teachers from eight purposefully selected schools with high rates of inaccurate (false positive) referrals. Interviews were also conducted with three optometrists from a not-for profit private eye care hospital that had trained the teachers. Interviews were audio recorded and professionally transcribed. NVIVO software version 12 was used to code and thematically analyze the data. Results Findings suggest that the importance of school-based vision screening was well understood and appreciated by the teachers and optometrists. Most participants felt that there was a strong level of support for the vision screening programme within the participating schools. However, there were a number of operational issues undermining the quality of screening. Eight teachers felt that the duration of the training was insufficient; the training was rushed; six teachers said that the procedures were not sufficiently explained, and the teachers had no time to practice. The screening protocol was not always followed by the teachers. Additionally, many teachers reported being overburdened with other work, which affected both their levels of participation in the training and the time they spent on the screening. Conclusions School-based vision screening by teachers is a cost-effective strategy to detect and treat children’s vision impairment early on. In the programme reviewed here however, a significant number of teachers over referred children to ophthalmic services, overwhelming their capacity and undermining the efficiency of the approach. To maximise the effectiveness and efficiency of school-based screening, future initiatives should give sufficient attention to the duration of the teacher training, experience of trainers, support supervision, refresher trainings, regular use of the screening guidelines, and the workload and motivation of those trained.

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