scholarly journals Care-seeking behaviour and socio-economic burden associated with uncomplicated malaria in the Democratic Republic of Congo

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nadine Kalenda Kayiba ◽  
Doudou Malekita Yobi ◽  
Brecht Devleesschauwer ◽  
Dieudonné Makaba Mvumbi ◽  
Pius Zakayi Kabututu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Uncomplicated Malaria ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Economic Costs ◽  
The Cost

Abstract Background This study aimed to estimate the socio-economic costs of uncomplicated malaria and to explore health care-seeking behaviours that are likely to influence these costs in the Democratic Republic of Congo (DRC), a country ranked worldwide as the second most affected by malaria. Methods In 2017, a cross-sectional survey included patients with uncomplicated malaria in 64 healthcare facilities from 10 sentinel sites of the National Malaria Control Programme (NMCP) in the DRC. A standard questionnaire was used to assess health care-seeking behaviours of patients. Health-related quality of life (HRQL) and disutility weights (DW) of illness were evaluated by using the EuroQol Group’s descriptive system (EQ-5D-3L) and its visual analogue scale (EQ VAS). Malaria costs were estimated from a patient’s perspective. Probabilistic sensitivity analyses (PSA) evaluated the uncertainty around the cost estimates. Generalized regression models were fitted to assess the effect of potential predictive factors on the time lost and the DW during illness. Results In total, 1080 patients (age: 13.1 ± 14 years; M/F ratio: 1.1) were included. The average total costs amounted to US$ 36.3 [95% CI 35.5–37.2] per malaria episode, including US$ 16.7 [95% CI 16.3–17.1] as direct costs and US$ 19.6 [95% CI 18.9–20.3] indirect costs. During care seeking, economically active patients and their relatives lost respectively 3.3 ± 1.8 and 3.4 ± 2.1 working days. This time loss occurred mostly at the pre-hospital stage and was the parameter associated the most with the uncertainty around malaria cost estimates. Patients self-rated an average 0.36 ± 0.2 DW and an average 0.62 ± 0.3 EQ-5D index score per episode. A lack of health insurance coverage (896 out of 1080; 82.9%) incurred substantially higher costs, lower quality of life, and heavier DW while leading to longer time lost during illness. Residing in rural areas incurred a disproportionally higher socioeconomic burden of uncomplicated malaria with longer time lost due to illness and limited access to health insurance mechanisms. Conclusion Uncomplicated malaria is associated with high economic costs of care in the DRC. Efforts to reduce the cost-of-illness should target time lost at the pre-hospital stage and social disparities in the population, while reinforcing measures for malaria control in the country.

Influence of the Severity of Stress Urinary Incontinence on Quality of Life, Health Care Seeking, and Treatment: A National Cross-Sectional Survey

2006 ◽  
Vol 50 (4) ◽  
pp. 818-825 ◽  
Author(s):  
Isabelle Gasquet ◽  
Stéphanie Tcherny-Lessenot ◽  
Pierre Gaudebout ◽  
Brigitte Bosio Le Goux ◽  
Patrick Klein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Cross Sectional Survey ◽  
Cross Sectional

Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

2020 ◽  
Vol 30 (11) ◽  
pp. 1710-1722
Author(s):  
Bincy Mathew ◽  
Devaki Nambiar
Keyword(s):  
Health Care ◽  
Urban Health Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Reform Agenda ◽  
National Capital ◽  
Health Related ◽  
Progression Of Disease ◽  
Residency Status

Many studies have reported on issues of accessibility and quality of health care among the different vulnerable subgroups in urban locations. To date, no study has been done on the challenges faced by health care–seeking migrants (those traveling to cities for health reasons). This qualitative study used in-depth interviews and nonparticipant observation to examine the health problems, health care–seeking trajectories, and challenges faced by health care–seeking migrants in Delhi, India. Participants described long courses of health care seeking, typically from the district to the state capital to the national capital. There were variegated paths to health care seeking characterized by delays in service utilization, progression of disease, and cost escalation. The challenge relating to the delay in receiving health care was exacerbated by the residency status of health care–seeking migrants. In conclusion, health-related migration is associated with shared but also unique barriers to health care seeking. India’s urban health care reform agenda needs to cater to the needs of this population.

Cost-effectiveness analysis: role and implications

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 135-140 ◽  
Author(s):  
G Marsden ◽  
D Wonderling
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cost Effectiveness ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Health Gain ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Background: Cost-effectiveness analysis (CEA) is often misperceived to be a cost-cutting exercise. The intention of CEA is not to identify and implement cheap technologies, but rather those which offer maximum health gain, subject to available funds. Such analysis is crucial for decision making in health care, as tight budget constraints mean spending in one area of healthcare displaces spending elsewhere. Therefore in order to achieve the greatest health gain for the overall population, treatments must be selected which provide the greatest health gain within the available funds. Summary: The relevance of CEA in health care systems is explained, using varicose vein treatment in the UK NHS as an example. Treatment for varicose veins is often not commissioned to at a local level, most likely because it is misperceived to be a cosmetic problem. However, this view does not take into account the impact of quality of life. CEA balances costs against a quantitative measure of health related quality of life, and could therefore be used to determine whether it is cost-effective to provide varicose vein treatment. The current literature on the cost-effectiveness of varicose vein treatment is reviewed, and an overview of cost-effectiveness principles is provided. Concepts such as economic modelling, incremental cost-effectiveness ratios (ICERs), net monetary benefit (NMB) and sensitivity analysis are explained, using examples relevant to varicose veins where appropriate. Conclusion: This article explains how, far from cutting costs and sacrificing patient health, CEA provides a useful tool to maximise the health of the population in the face of ever tightening budget constraints. CEA could be used to compare the cost-effectiveness of the various treatment options for varicose veins, and efficiencies realised.

scholarly journals Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy

2020 ◽  
pp. 096452842092028
Author(s):  
Alex Molassiotis ◽  
Bryony Dawkins ◽  
Roberta Longo ◽  
Lorna KP Suen ◽  
Hui Lin Cheng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Peripheral Neuropathy ◽  
Usual Care ◽  
Base Case ◽  
Cost Effective Treatment ◽  
The Cost

Objective To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong. Methods A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI). Results Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of −1.8 and −1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of −1.5 and −0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis. Conclusion While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources. Trial registration number NCT02553863 (ClinicalTrials.gov) post-results.

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

2002 ◽  
Vol 22 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karin Sennfält ◽  
Martin Magnusson ◽  
Per Carlsson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Age Group ◽  
The Cost ◽  
Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

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