scholarly journals A Review of the User Fees Policy for Primary Healthcare Consultations in Botswana: Problems With Effective Planning, Implementation and Evaluation

2021 ◽  
Author(s):  
Vincent Pagiwa ◽  
Alan Shiell ◽  
Simon Barraclough ◽  
Onalenna Seito-Kgokgwe
Keyword(s):  
Health Care ◽  
Universal Access ◽  
Organizational Capacity ◽  
Cost Effective ◽  
User Fees ◽  
User Charges ◽  
Revenue Collection ◽  
The Government ◽  
The Cost ◽  
Study Participants

Background: The Government of Botswana introduced user-fees for primary health care consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. Methods: This qualitative study involved interviews with 32 key informants: 18 policy makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. Results: Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. Conclusion: If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in health care as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

Principles of Cost-Effective Resource Allocation in Health Care organizations

1990 ◽  
Vol 6 (1) ◽  
pp. 93-103 ◽  
Author(s):  
Milton C. Weinstein
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Health Care Organizations ◽  
Cost Effective ◽  
Limited Resources ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Common Understanding ◽  
Analytical Errors

Cost-effectiveness analysis (CEA) is a method of economic evaluation that can be used to assess the efficiency with which health care technologies use limited resources to produce health outputs. However, inconsistencies in the way that such ratios are constructed often lead to misleading conclusions when CEAs are compared. Some of these inconsistencies, such as failure to discount or to calculate incremental ratios correctly, reflect analytical errors that, if corrected, would resolve the inconsistencies. Others reflect fundamental differences in the viewpoint of the analysis. The perspectives of different decision-making entities can properly lead to different items in the numerator and denominator of the cost-effectiveness (C/E) ratio. Producers and consumers of CEA need to be more conscious of the perspectives of analysis, so that C/E comparisons from a given perspective are based upon a common understanding of the elements that are properly included.

CANADA'S FAILURE

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 569-569
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
New England ◽  
Care Delivery ◽  
Health Care Facilities ◽  
User Fees ◽  
Capital Expenditures ◽  
The Past ◽  
Care Facilities ◽  
Dog Owners ◽  
The Government

The direct costs of Canada's national health insurance are not as troublesome as the distortive effect they have on health care delivery. Health care facilities have been forced to cut back severely on their capital expenditures, thus depleting the availability of advanced medical equipment. As a result, many patients must seek advanced treatment elsewhere. According to a recent study reported in the New England Journal of Medicine, nearly one-third of Canada's doctors have sent patients outside the country for treatment during the past five years. About 10% of all British Columbia residents requiring cancer therapy have been sent to the U.S. In Toronto, because the government doesn't provide enough money for personnel, 3,000 beds have been removed from service, while thousands of patients are on waiting lists for admission. Even where advanced equipment is available, bureaucratic absurdities prevent proper use. According to the April issue of "Fraser Forum," dogs at York Central Hospital in metropolitan Toronto were able to get CAT scans immediately while humans were put on a waiting list. The reason? Canadian patients are not allowed to pay for CAT scans, and the procedure costs too much to operate more than a few hours a day for nonpaying customers. Dog owners, on the other hand, were permitted to pay to use it. The user fees paid by the dog owners allowed the machine to operate longer, thus more human patients could be scanned. When this information was released, instead of considering user fees for humans, the Canadian government banned the tests for dogs!

scholarly journals Improving Access to Cancer Treatments: The Role of Biosimilars

2017 ◽  
Vol 3 (5) ◽  
pp. 596-610 ◽  
Author(s):  
Rakesh Chopra ◽  
Gilberto Lopes
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Health Care Providers ◽  
Cost Effective ◽  
Cancer Therapies ◽  
Care Providers ◽  
Cancer Treatments ◽  
Reference Drug ◽  
Effective Use ◽  
The Cost

Biologics play a key role in cancer treatment and are principal components of many therapeutic regimens. However, they require complex manufacturing processes, resulting in high cost and occasional shortages in supply. The cost of biologics limits accessibility of cancer treatment for many patients. Effective and affordable cancer therapies are needed globally, more so in developing countries, where health care resources can be limited. Biosimilars, which have biologic activity comparable to their corresponding reference drugs and are often more cost effective, have the potential to enhance treatment accessibility for patients and provide alternatives for decision makers (ie, prescribers, regulators, payers, policymakers, and drug developers). Impending patent expirations of several oncology biologics have opened up a vista for the development of corresponding biosimilars. Several countries have implemented abbreviated pathways for approval of biosimilars; however, challenges to their effective use persist. Some of these include designing appropriate clinical trials for assessing biosimilarity, extrapolation of indications, immunogenicity, interchangeability with the reference drug, lack of awareness and possibly acceptance among health care providers, and potential political barriers. In this review, we discuss the potential role and impact of biosimilars in oncology and the challenges related to their adoption and use. We also review the safety and efficacy of some of the widely used biosimilars in oncology and other therapeutic areas (eg, bevacizumab, darbepoetin, filgrastim, rituximab, and trastuzumab).

American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care

2009 ◽  
Vol 27 (23) ◽  
pp. 3868-3874 ◽  
Author(s):  
Neal J. Meropol ◽  
Deborah Schrag ◽  
Thomas J. Smith ◽  
Therese M. Mulvey ◽  
Robert M. Langdon ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Oncology ◽  
Cancer Care ◽  
Cost Effective ◽  
The United States ◽  
Cost Of Care ◽  
High Quality ◽  
American Society ◽  
The Cost

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

scholarly journals Occupational Screening for Latent Tuberculosis Infection

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Sara D. Khangura ◽  
Melissa Severn
Keyword(s):  
Health Care ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Cost Effective ◽  
Tuberculosis Infection ◽  
Economic Evaluations ◽  
Repeated Testing ◽  
Health Care Settings ◽  
Targeted Testing ◽  
The Cost

In people at risk of occupational exposure to tuberculosis, targeted testing for latent tuberculosis infection (e.g., testing for high-risk individuals, testing after tuberculosis exposure) appears to be more cost-effective than repeated testing, such as testing once a year or every 3 years (findings based on 2 economic evaluations that assessed the cost-effectiveness of repeated latent tuberculosis infection screening in workers of health care settings).

scholarly journals HIGHER SECONDARY SCHOOL STUDENTS PERCEPTION ABOUT ONLINE CLASSES DURING PANDEMIC WITH REFERENCE TO SELECTED SCHOOLS IN TIRUCHIRAPPALLI CITY

2021 ◽  
Vol 9 (5) ◽  
pp. 1319-1323
Author(s):  
S. Arokia Punitha ◽  
Keyword(s):  
Universal Access ◽  
Learning Experience ◽  
Educational Institution ◽  
Secondary Data ◽  
Online Classes ◽  
School Students ◽  
Independent Variables ◽  
Learning Platforms ◽  
The Government ◽  
The Cost

The Education system is changing rapidly with all schools preferring online learning platforms to enhance the students learning experience. Majority of the educational institution continued their online classes immediately realising the situation. This study was undertaken to know the students perception about the online classes for during COVID -19 pandemic in Tiruchirapalli city. Primary and Secondary data collected from respondents will be divided into independent variables and dependent variables. These independent variables are conceptualized by using a set of 5-point Likert scale statements to measure the students perception about online classes. Both the variables are supported by students perception about online classes. The online classes became the new normal for most school and college students, the cost of data has been another digital obstacle to surmount even for those with access to smartphones and internet connectivity. The government must introduce policies or an ordinance ensuring universal access to the internet for students stemming from which more systemic support could be offered.

scholarly journals An Economic Evaluation of Triage Tools For Patients With Suspected Severe Injuries In England

2021 ◽  
Author(s):  
Daniel Pollard ◽  
Gordon Fuller ◽  
Steve Goodacre ◽  
Eveline A. J. van Rein ◽  
F. Waalwijk Job ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Sensitivity And Specificity ◽  
Major Trauma ◽  
Cost Effective ◽  
Decision Makers ◽  
Life Years ◽  
Trauma Triage ◽  
The Cost ◽  
Injured Patients

Abstract BackgroundMany health care systems triage injured patients to major trauma centres (MTCs) or local hospitals by using triage tools and paramedic judgement. Triage tools are typically assessed by whether patients with an Injury Severity Score (ISS)≥16 go to an MTC and whether patients with an ISS<16 are sent to their local hospital. There is a trade‐off between sensitivity and specificity of triage tools, with the optimal balance being unknown. We conducted an economic evaluation of major trauma triage tools to identify which tool would be considered cost-effective by UK decision makers.MethodsA patient-level, probabilistic, mathematical model of a UK major trauma system was developed. Patients with an ISS≥16 who were only treated at local hospitals had worse outcomes compared to being treated in an MTC. Nine empirically derived triage tools, from a previous study, were examined so we assessed triage tools with realistic trade-offs between triage tool sensitivity and specificity. Lifetime costs, lifetime quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each tool and compared to maximum acceptable ICERs (MAICERs) in England. ResultsFour tools had ICERs within the normal range of MAICERs used by English decision makers (£20,000 to £30,000 per QALY gained). A low sensitivity (28.4%) and high specificity (88.6%) would be cost-effective at the lower end of this range while higher sensitivity (87.5%) and lower specificity (62.8%) was cost-effective towards the upper end of this range. These results were sensitive to the cost of MTC admissions and whether MTCs had a benefit for patients with an ISS between 9 and 15. ConclusionsThe cost-effective triage tool depends on the English decision maker’s MAICER for this health problem. In the usual range of MAICERs, cost-effective prehospital trauma triage involves clinically suboptimal sensitivity, with a proportion of seriously injured patients (at least 10%) being initially transported to local hospitals. High sensitivity trauma triage requires development of more accurate decision rules; research to establish if patients with an ISS between 9 and 15 benefit from MTCs; or, inefficient use of health care resources to manage patients with less serious injuries at MTCs.

Continuation of Anti-TNF in Patients With Ulcerative Colitis in Remission Is Not Cost-effective Compared With Treatment Withdrawal: A Markov Model

2020 ◽  
Author(s):  
Remi Mahmoud ◽  
Chris van Lieshout ◽  
Geert W J Frederix ◽  
Bindia Jharap ◽  
Bas Oldenburg
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Cost Effective ◽  
Health Care Expenditures ◽  
Increased Risk ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

Abstract Background and Aims Anti-tumour necrosis factor alpha [anti-TNF] treatment accounts for 31% of health care expenditures associated with ulcerative colitis [UC]. Withdrawal of anti-TNF in patients with UC in remission may decrease side effects and infections, while promoting cost containment. Approximately 36% of patients relapse within 12–24 months of anti-TNF withdrawal, but reintroduction of treatment is successful in 80% of patients. We aimed to evaluate the cost-effectiveness of continuation versus withdrawal of anti-TNF in patients with UC in remission. Methods We developed a Markov model comparing cost-effectiveness of anti-TNF continuation versus withdrawal, from a health care provider perspective. Transition probabilities were calculated from literature, or estimated by an expert panel of 11 gastroenterologists. Deterministic and probabilistic sensitivity analyses were performed to account for assumptions and uncertainty. The cost-effectiveness threshold was set at an incremental cost-effectiveness ratio of €80,000 per quality-adjusted life-year [QALY]. Results At 5 years, anti-TNF withdrawal was less costly [-€10,781 per patient], but also slightly less effective [-0.04 QALY per patient] than continued treatment. Continuation of anti-TNF compared with withdrawal costs €300,390/QALY, exceeding the cost-effectiveness threshold. Continued therapy would become cost-effective if the relapse rate following anti-TNF withdrawal was ≥43% higher, or if adalimumab or infliximab [biosimilar] prices fell below €87/40 mg and €66/100 mg, respectively. Conclusions Continuation of anti-TNF in UC patients in remission is not cost-effective compared with withdrawal. A stop-and-reintroduction strategy is cost-saving but is slightly less effective than continued therapy. This strategy could be improved by identifying patients at increased risk of relapse.

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