The economic burden of cervical cancer in Eswatini: Societal perspective

Background Cervical cancer imposes considerable economic burden on societies and individuals. There is lack of evidence regarding this from the developing world and particularly from sub-Saharan Africa. Therefore, the study aimed to estimate the societal costs of cervical cancer in Eswatini. Materials and methods The cost of illness study (CoI) was applied using national specific clinical and registry data from hospitals, registries and reports to determine the prevalence of cervical intraepithelial neoplasia (CIN) and cervical cancer in Eswatini in 2018. Cost data included direct medical costs (health care utilization in inpatient and outpatient care), direct non-medical costs (patient costs for traveling) and indirect costs based on productivity loss due to morbidity (patient time during diagnosis and treatment) and premature mortality. Results The estimated total annual cost for cervical cancer was $19 million (ranging between $14 million and $24 million estimated with lower and upper bounds). Direct cost represented the majority of the costs at 72% ($13.7 million) out of which total pre-cancerous treatment costs accounted for 0.7% ($94,161). The management of invasive cervical cancer was the main cost driver with costs attributable to treatment for FIGO III and FIGO IV representing $1.7 million and $8.7 million respectively. Indirect costs contributed 27% ($5.3 million) out of which productivity loss due to premature mortality represented the majority at 67% ($3.5 million). Conclusion The economic burden of cervical cancer in Eswatini is substantial. National public health prevention strategies with prophylactic HPV vaccine and screening for cervical lesions should therefore be prioritized to limit the extensive costs associated with cervical cancer.

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Mapping evidence on the distribution of the costs associated with cancer of prostate, cervix, and female breast in the sub-Saharan Africa: protocol for a scoping review

Systematic Reviews ◽

10.1186/s13643-021-01672-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Cebisile Ngcamphalala ◽

Ellinor Ostensson ◽

Mbuzeleni Hlongwa ◽

Themba G. Ginindza

Keyword(s):

Systematic Reviews ◽

Scoping Review ◽

Economic Burden ◽

Indirect Costs ◽

Economic Consequences ◽

Sub Saharan Africa ◽

Breast Cancers ◽

Direct And Indirect Costs ◽

Female Breast ◽

Sub Saharan

Abstract Background Despite the well-documented information on cancer prevention and management, among noncommunicable diseases (NCDs), globally, cancer continues to be the second leading cause of morbidity and mortality with devastating economic consequences. The burden is disproportionately more among developing countries and the extent of evidence available on the economic consequences (direct and indirect costs) of cancer remains unknown in low-income countries particularly in the sub-Saharan region. Understanding the costs of illness is important to inform decision-making on setting up health care policies and informing economic evaluation of interventions. This study aims to map evidence on the distribution of the economic burden (direct and indirect costs) associated with prevention, diagnosis, and treatment of three predominant cancers: prostate, cervix, and female breast in the sub-Saharan Africa. Methods This scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR), and will be conducted following Arksey and O’Malley’s framework. We will search PubMed/MEDLINE, Web of Science, CINHAL (via EBSCOhost platform), Science Direct, Cochrane Database of Systematic Reviews, Africa-Wide Information, Google Scholar, and WHO Library. We will perform hand-searching of the reference lists of included studies and other relevant documents. Two reviewers will independently screen all citations, full-text articles, and abstract data. We will include primary studies from all study designs reporting costs associated with prevention, diagnosis and treatment of prostate, cervical, and breast cancers in the sub-Saharan region. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. A narrative summary of findings will be presented. Discussion This review will map the extent of information available on the economic burden (direct and indirect costs) of prostate, cervical, and breast cancers in the sub-Saharan region. Further guidance for future research in the subject area will be discussed. Systematic review registration Open Science Framework

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Abstract 19839: Clinical and Economic Burden of Rheumatic Heart Disease in Low-Income Nations: Estimating the Cost-of-Illness in India and Uganda

Circulation ◽

10.1161/circ.130.suppl_2.19839 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alexander T Sandhu ◽

Kathikeyan G ◽

Ann Bolger ◽

Emmy Okello ◽

Dhruv S Kazi

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Cost Of Illness ◽

Economic Burden ◽

Indirect Costs ◽

Medical Costs ◽

Discrete State ◽

Direct Medical Costs ◽

The Cost ◽

Rheumatic Heart

Introduction: Rheumatic heart disease (RHD) strikes young adults at their peak economic productivity. Defining the global economic burden of RHD may motivate investments in research and prevention, yet prior approaches considering only medical costs may have underestimated the cost of illness. Objectives: To estimate the clinical and economic burden of RHD in India and Uganda. Outcomes were disability-adjusted life years (DALYs), direct medical costs, and indirect costs due to disability and premature mortality (2012 USD). Methods: We used a discrete-state Markov model to simulate the natural history of RHD using country-, age-, and gender-specific estimates from the literature and census data. We estimated direct medical costs from WHO-CHOICE and Disease Control and Prevention 3 publications. We conservatively estimated indirect costs (lost earnings and imputed caregiver costs) from World Bank data using novel economic methods. Results: In 2012, RHD generated 6.1 million DALYs in India and cost USD 10.7 billion (Table 1), including 1.8 billion in direct medical costs and 8.9 billion in indirect costs. During the same period, RHD produced 216,000 DALYs in Uganda, and cost USD 414 million, and, as in India, indirect costs represented the majority (88%) of the cost of illness. In both countries, women accounted for the majority (71-80%) of the DALYs; in Uganda, women bore 75% of the total cost. In sensitivity analyses, higher progression rates for subclinical disease doubled direct costs and DALYs. Conclusion: RHD exacts an enormous toll on the populations of India and Uganda, and its economic burden may be grossly underestimated if indirect costs are not systematically included. Women bear a disproportionate clinical burden from pregnancy-related complications. These results suggest that effective prevention and screening of RHD may represent a sound public health investment, particularly if targeted at high-risk subgroups such as young women.

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The Economic Burden of Brain Disability in Korea, 2008-2011

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958020936396 ◽

2020 ◽

Vol 57 ◽

pp. 004695802093639

Author(s):

Hyun-Jin Kim ◽

Seung Hee Ho ◽

Sol Lee ◽

In-Hwan Oh ◽

Ju Hee Kim ◽

...

Keyword(s):

Economic Burden ◽

Health Management ◽

Productivity Loss ◽

Indirect Costs ◽

Premature Death ◽

Persons With Disabilities ◽

Rate Of Increase ◽

Nationally Representative ◽

All Diseases ◽

Death Data

This study estimated the economic burden of people with brain disability in Korea during 2008-2011 using nationally representative data and was conducted to use the results as an evidence for determining the resources allocation of people with brain disability. We used a prevalence-based approach to estimate the economic burden, classified by direct costs (medical costs and nonmedical costs) and indirect costs (productivity loss of morbidity and premature death). Data from the National Health Insurance Service, the National Disability Registry, the National survey on persons with disabilities, the Korea National Statistical Office’s records of causes of death, and the Labor Statistics were used to calculate direct and indirect costs. The treated prevalence of brain disability increased from 0.26% (2008) to 0.35% (2011). Total economic burden of brain-related diseases was US$1.88 billion in 2008 and increased to US$2.90 billion in 2011, with a 54% rate of increase. The economic burden of all diseases, which was 1.2 to 1.4 times higher than that of brain-related diseases, accounted for US$2.61 billion in 2008 and US$3.62 billion in 2011, increasing by 39%. Owing to the growing occurrence of brain disability, the annual prevalence and related costs are increasing. Health management programs are necessary to reduce the economic burden of brain disability in Korea.

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The economic impact of air pollution: a European assessment

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.084 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Conti ◽

P Ferrara ◽

L S D'Angiolella ◽

S C Lorelli ◽

G Agazzi ◽

...

Keyword(s):

Air Pollution ◽

Economic Burden ◽

Indirect Costs ◽

Premature Mortality ◽

Cochrane Library ◽

Policy Makers ◽

Life Years ◽

Health Related ◽

Disease Study ◽

The Impact

Abstract Background In 2017, the Global Burden of Disease Study estimated that in Europe 0.42 million deaths and 8.9 million disability-adjusted life years were attributable to air pollution. Monetizing this burden is a key step for estimating benefits of exposure reduction strategies. However, robust and synthetic estimates of direct (e.g. due to hospitalizations or medications) and indirect (e.g. due to premature mortality or loss of productivity) health-related costs of air pollution seem to be still lacking. We carried out a systematic review, aimed at identifying evidence from research in Europe. Methods We searched 5 electronic databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web Of Science) in which we applied algorithms tracing keywords such as “cost of illness”, “health care costs”, “economics” and synonyms, together with “air pollution” and synonyms. We limited our search to articles written in English and Italian, without date restriction. Results The initial search retrieved 2420 records. 200 were classified as relevant, and 38 fulfilled inclusion criteria. Most of them (68%) were published after 2010. 26% were multi-country studies, while the remaining focused on a single country or city. Investigated pollutants were usually particulate matter (79% of the studies) and nitrogen oxides (37%). The approaches to the economic analysis were heterogeneous: estimates could include direct and/or indirect costs. Among the studies, the most comprehensive one (12 countries) estimated that complying with WHO guidelines would avert €31 billion yearly, of which €19 million due to hospitalizations. Conclusions Over the last decade, progress has been made in evaluating the economic burden of air pollution. However, estimates based on indirect costs are affected by high levels of uncertainty, while those based on direct costs are more robust and should be further investigated, since they are crucial information for healthcare policy makers. Key messages Air pollution poses a high economic burden on European countries, mainly due to social costs. More attention should be devoted to estimating direct healthcare costs of air pollution, in order to properly inform policy makers about the impact on healthcare systems.

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Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub-Saharan Africa

International Journal of Cancer ◽

10.1002/ijc.28425 ◽

2013 ◽

Vol 134 (6) ◽

pp. 1389-1398 ◽

Cited By ~ 82

Author(s):

Lynette Denny ◽

Isaac Adewole ◽

Rose Anorlu ◽

Greta Dreyer ◽

Manivasan Moodley ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Invasive Cervical Cancer ◽

Sub Saharan Africa ◽

Type Distribution ◽

Sub Saharan

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Rethinking the economic costs of hospitalization for malaria: accounting for the comorbidities of malaria patients in western Kenya

Malaria Journal ◽

10.1186/s12936-021-03958-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Caroline Watts ◽

Harrysone Atieli ◽

Jason Alacapa ◽

Ming-Chieh Lee ◽

Guofa Zhou ◽

...

Keyword(s):

Health System ◽

Economic Burden ◽

Indirect Costs ◽

Malaria Diagnosis ◽

Medical Costs ◽

Malaria Episode ◽

Economic Costs ◽

Western Kenya ◽

The Mean ◽

Household Costs

Abstract Background Malaria causes significant mortality and morbidity in sub-Saharan Africa, especially among children under five years of age and places a huge economic burden on individuals and health systems. While this burden has been assessed previously, few studies have explored how malaria comorbidities affect inpatient costs. This study in a malaria endemic area in Western Kenya, assessed the total treatment costs per malaria episode including comorbidities in children and adults. Methods Total economic costs of malaria hospitalizations were calculated from a health system and societal perspective. Patient-level data were collected from patients admitted with a malaria diagnosis to a county-level hospital between June 2016 and May 2017. All treatment documented in medical records were included as health system costs. Patient and household costs included direct medical and non-medical expenses, and indirect costs due to productivity losses. Results Of the 746 patients admitted with a malaria diagnosis, 64% were female and 36% were male. The mean age was 14 years (median 7 years). The mean length of stay was three days. The mean health system cost per patient was Kenyan Shilling (KSh) 4288 (USD 42.0) (95% confidence interval (CI) 95% CI KSh 4046–4531). The total household cost per patient was KSh 1676 (USD 16.4) (95% CI KSh 1488–1864) and consisted of: KSh 161 (USD1.6) medical costs; KSh 728 (USD 7.1) non-medical costs; and KSh 787 (USD 7.7) indirect costs. The total societal cost (health system and household costs) per patient was KSh 5964 (USD 58.4) (95% CI KSh 5534–6394). Almost a quarter of patients (24%) had a reported comorbidity. The most common malaria comorbidities were chest infections, diarrhoea, and anaemia. The inclusion of comorbidities compared to patients with-out comorbidities led to a 46% increase in societal costs (health system costs increased by 43% and patient and household costs increased by 54%). Conclusions The economic burden of malaria is increased by comorbidities which are associated with longer hospital stays and higher medical costs to patients and the health system. Understanding the full economic burden of malaria is critical if future malaria control interventions are to protect access to care, especially by the poor.

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The National Economic Burden of Rare Disease in United States in 2019

10.21203/rs.3.rs-1046815/v1 ◽

2021 ◽

Author(s):

Grace Yang ◽

Inna Cintina ◽

Anne Pariser ◽

Elisabeth Oehrlein ◽

Jamie Sullivan ◽

...

Keyword(s):

Rare Disease ◽

Direct Medical Cost ◽

Medical Cost ◽

Economic Burden ◽

Claims Data ◽

Indirect Costs ◽

Medical Costs ◽

Hospital Inpatient ◽

Care Providers ◽

National Economic

Abstract Background: To provide a comprehensive assessment of the total economic burden of rare diseases (RD) in the U.S. in 2019.We followed a prevalence-based approach that combined the prevalence of 379 RDs with the per-capita direct medical and indirect costs, to derive the national economic burden by patient age and type of RD. To estimate prevalence and the direct medical cost of RD, we used claims data from three sources: Medicare 5% Standard Analytical File, Transformed Medicaid Statistical Information System, and Optum claims data for the privately insured. To estimate indirect and non-medical cost components, we worked with the rare disease community to design and implement a primary survey.Results: There were an estimated 15.5 million U.S. children (N=1,322,886) and adults (N=14,222,299) with any of the 379 RDs in 2019 with a total economic burden of $997 billion, including a direct medical cost of $449 billion (45%), $437 billion (44%) in indirect costs, and $111 billion (11%) in non-medical costs. The top drivers for excess medical costs associated with RD are hospital inpatient care and prescription medication; the top indirect cost categories are labor market productivity losses due to absenteeism, presenteeism, and forced early retirement.Conclusions: Our findings highlight the scale of the RD economic burden and call for immediate attention from the scientific communities, policy leaders, and other key stakeholders such as health care providers and employers, to think innovatively and collectively, to identify new ways to help improve the care, management, and treatment of these often-devastating diseases.

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The Economic Burden of Cancers Attributable to Infection in the Republic of Korea: A Prevalence-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207592 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7592

Author(s):

Thi Xuan Trinh Nguyen ◽

Minji Han ◽

Moran Ki ◽

Young Ae Kim ◽

Jin-Kyoung Oh

Keyword(s):

Cancer Patients ◽

Economic Burden ◽

Productivity Loss ◽

Population Attributable Fraction ◽

Indirect Costs ◽

Premature Death ◽

Direct Costs ◽

Income Loss ◽

Future Income ◽

The Republic

Infection is a major cause of cancers. We estimated the economic burden of cancers attributable to infection in 2014 in Korea, where cancer causing infection is prevalent, but the economic burden of it has never been examined. Cancer patients were defined as those having made medical claims as recorded by the National Health Insurance Service, which is a mandatory insurance for all citizen. We multiplied the costs by the population-attributable fraction for each type of cancer. The study included direct and indirect costs, where direct costs comprised direct medical and non-medical costs of inpatients and outpatients, while indirect costs were estimated by identifying future income loss due to premature death, productivity loss during hospitalization/outpatient visits, and job loss. In 2014, there were 100,054 infection-related cancer patients, accounting for 10.7% of all Korean cancer cases for that year. Direct costs of cancers associated with infection stood at nearly USD 676.9 million, while indirect costs were much higher at USD 2.57 billion. The average expenditure of a typical patient was USD 32,435. Economic burden of cancers attributable to infection is substantial in Korea, accounting for 0.23% of the national gross domestic product and 1.36% of national healthcare expenditure in 2014.

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Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2019-032303 ◽

2020 ◽

Vol 10 (3) ◽

pp. e032303 ◽

Cited By ~ 1

Author(s):

Thi Tuyet Mai Kieu ◽

Hong Nhung Trinh ◽

Huy Tuan Kiet Pham ◽

Thanh Binh Nguyen ◽

Junice Yi Siu Ng

Keyword(s):

Health Insurance ◽

Indirect Costs ◽

Premature Mortality ◽

Medical Costs ◽

Second Phase ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Secondary Sources ◽

Working Age ◽

The Impact

ObjectiveThe prevalence of diabetes in Vietnam has increased from 2.5% in 2007 to 5.5% in 2017, but the burden of direct non-medical and indirect costs is unknown. The objective of this study was to estimate the direct non-medical costs and indirect costs due to type 2 diabetes mellitus (T2DM) and its associated complications among Vietnam Health Insurance System (VHIS) enrollees in Vietnam.DesignThe first phase was a cross-sectional survey of patients with T2DM. In the second phase, data from the previous phase were used to predict direct non-medical costs and presenteeism costs of VHIS enrollees diagnosed with T2DM based on demographic and clinical characteristics in 2017. The human-capital approach was used for the calculation of indirect costs.Setting and participantsThis study recruited 315 patients from a national hospital, a provincial hospital and a district hospital aged 18 or above, diagnosed with T2DM, enrolled in VHIS, and having at least one visit to hospitals between 1 June and 30 July 2018. The VHIS dataset contained 1,395,204 patients with T2DM.Outcome measuresThe direct non-medical costs and presenteeism were collected from the survey. Absenteeism costs were estimated from the VHIS database. Costs of premature mortality were calculated based on the estimates from secondary sources.ResultsThe total direct non-medical and indirect costs were US$239 million in 2017. Direct non-medical costs were US$78 million, whereas indirect costs were US$161 million. Costs of absenteeism, presenteeism and premature mortality corresponded to 17%, 73% and 10% of the indirect costs. Patients incurred annual mean direct non-medical costs of US$56. Annual mean absenteeism and presenteeism costs for patients in working age were US$61 and US$267, respectively.ConclusionsThe impact of T2DM on direct non-medical and indirect costs on diabetes is substantial. Direct non-medical and absenteeism costs were higher in patients with complications.

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Economic burden of cancers in Taiwan: a direct and indirect cost estimate for 2007–2017

BMJ Open ◽

10.1136/bmjopen-2019-036341 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036341

Author(s):

Shao-Yi Huang ◽

Ho-Min Chen ◽

Kai-Hsin Liao ◽

Bor-Sheng Ko ◽

Fei-Yuan Hsiao

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Resource Allocation ◽

Economic Burden ◽

Indirect Costs ◽

Female Breast Cancer ◽

Cost Driver ◽

Female Breast ◽

Driver Analysis ◽

The Cost

ObjectiveCancers result in significant economic burdens on patients, health sectors and society. Reliable burden estimates will help guide resource allocation. This study aimed to perform a nationwide cost analysis of the direct and indirect costs of the top ten most costly cancers, and acute coronary syndrome (ACS), as a comparison, in Taiwan.SettingA population-based cohort study.ParticipantsIn total, 545 221 patients with newly diagnosed cancer (lung cancer, female breast cancer, colorectal cancer, liver cancer, oral cancer, leukaemia, prostate cancer, non-Hodgkin's lymphoma, gastric cancer and oesophageal cancer) and 170 879 patients with ACS between 2007 and 2014 were identified.Primary and secondary outcome measuresDirect medical costs were calculated from claims recorded in the National Health Insurance Research Database . Indirect costs, comprising morbidity-associated and mortality-associated productivity losses, were estimated from public life expectancy, average wage and employment data. The costs incurred in the 3 years after diagnosis were assessed. As a comparison, the cost of ACS was also estimated using the same study frame. A cost driver analysis was conducted to identify factors impacting cancer costs.ResultsThe cancers with the highest mean direct medical costs and total costs were leukaemia (US$28 464) and oesophageal cancer (US$81 775), respectively. Indirect costs accounted for over 50% of the total economic burden of most cancers, except for prostate cancer and female breast cancer. The costs of ACS were lower than those of most cancers. From the cost driver analysis, older age at diagnosis significantly (p<0.05) decreased the total cost of cancer; in contrast, male, tumour metastasis, comorbidities and treatment in medical centres increased the costs.ConclusionsThis study demonstrates the comprehensive economic burden of the top 10 most costly cancers in Taiwan. These results are valuable for optimising healthcare resource allocation.

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