Household and Hospitalization Costs of Pediatric Dengue Illness in Colombo, Sri Lanka

Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0–3 years, 27%; 4–7 years, 29%; 8–12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68.0 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.

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Economic burden of managing oral cancer patients in Sri Lanka: a cross-sectional hospital -based costing study

BMJ Open ◽

10.1136/bmjopen-2018-027661 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027661 ◽

Cited By ~ 3

Author(s):

Hemantha Amarasinghe ◽

Ruwan Duminda Jayasinghe ◽

Dilantha Dharmagunawardene ◽

Manjula Attygalla ◽

Paul A Scuffham ◽

...

Keyword(s):

Sri Lanka ◽

Oral Cancer ◽

Healthcare System ◽

Indirect Costs ◽

Cross Sectional ◽

Capital Costs ◽

Costing Study ◽

Oral Cancer Patients ◽

Household Costs ◽

Negative Impacts

ObjectiveCancer of the oral cavity is the leading malignancy among males in Sri Lanka, and sixth among women. This study aimed to estimate costs of managing patients with oral cancer (OCA) in Sri Lanka for a 12 month period from diagnosis.DesignHospital based costing study.SettingsFour selected cancer treatment centres in Sri Lanka.ParticipantsSixty-nine OCA patients: 60 were males and 12 had recurrent tumours.OutcomeSocietal perspectives (healthcare, household and indirect costs) were itemised. Costs to the healthcare system included surgery, Intensive Care Unit (ICU) care, chemotherapy and radiotherapy. Capital costs including apportioned value of land, buildings, equipment and furniture. Household costs consisted of out of pocket expenditure for healthcare and indirect costs of lost income. Costs were estimated from the stage of presentation for treatment to 1 year of follow-up.ResultsMean cost of managing a single stage II OCA patient for 1 year was Sri Lankan rupees (SLR) 58 979 (US$394, at the midyear exchange rate in 2016) to the health system. Mean household cost was SLR 77 649 (US$518). The annual cost of managing a stage III or IV patient was SLR 303 620 (US$2027), with household costs of SLR 71 932 (US$480).ConclusionsOwing to the high incidence of OCA in Sri Lanka, the economic costs associated with these diseases are enormous, resulting in negative impacts on both the healthcare system and individual families, seriously impacting the country’s economy. Policy-makers should take note of this burden and increase steps for prevention and control of this devastating disease.

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Healthcare Expenditures Associated with Heart Failure in Saudi Arabia: A Cost of Illness Study

Healthcare ◽

10.3390/healthcare9080988 ◽

2021 ◽

Vol 9 (8) ◽

pp. 988

Author(s):

Ahmed Alghamdi ◽

Eman Algarni ◽

Bander Balkhi ◽

Abdulaziz Altowaijri ◽

Abdulaziz Alhossan

Keyword(s):

Heart Failure ◽

Saudi Arabia ◽

Cost Of Illness ◽

Economic Burden ◽

Indirect Costs ◽

Health Care Expenditures ◽

Decision Makers ◽

Hospitalization Costs ◽

Illness Study ◽

The Cost

Heart failure (HF) is considered to be a global health problem that generates a significant economic burden. Despite the growing prevalence in Saudi Arabia, the economic burden of HF is not well studied. The aim of this study was to estimate the health care expenditures associated with HF in Saudi Arabia from a social perspective. We conducted a multicenter cost of illness (COI) study in two large governmental centers in Riyadh, Saudi Arabia using 369 HF patients. A COI model was developed in order to estimate the direct medical costs associated with HF. The indirect costs of HF were estimated based on a human capital approach. Descriptive and inferential statistics were analyzed. The direct medical cost per HF patient was $9563. Hospitalization costs were the major driver in total spending, followed by medication and diagnostics costs. The cost significantly increased in line with the disease progression, ranging from $3671 in class I to $16,447 in class IV. The indirect costs per working HF patient were $4628 due to absenteeism, and $6388 due to presenteeism. The economic burden of HF is significantly high in Saudi Arabia. Decision makers need to focus on allocating resources towards strategies that prevent frequent hospitalizations and improve HF management and patient outcomes in order to lower the growing economic burden.

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Economic burden of childhood diarrhea in Burundi

Global Health Research and Policy ◽

10.1186/s41256-021-00194-3 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Fulgence Niyibitegeka ◽

Arthorn Riewpaiboon ◽

Sitaporn Youngkong ◽

Montarat Thavorncharoensap

Keyword(s):

Economic Burden ◽

Cost Model ◽

Primary Treatment ◽

Management Program ◽

Community Based ◽

Factors Affecting ◽

Hospitalization Costs ◽

Illness Study ◽

The Cost ◽

Substantial Economic Burden

Abstract Background In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. Methods The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients’ caregivers and review of patients’ medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. Results One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. Conclusion Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.

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Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Health Scope ◽

10.5812/jhealthscope.117711 ◽

2022 ◽

Vol In Press (In Press) ◽

Author(s):

Maryam Shirvani Shiri ◽

Sara Emamgholipour ◽

Rajabali Daroudi ◽

Maryam Tatary ◽

Zohreh Kazemi ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Influencing Factors ◽

Financial Burden ◽

First Grade ◽

Ischemic Heart ◽

Icu Admission ◽

Medical Supplies ◽

Hospitalization Costs ◽

The Mean

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

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Cost Effectiveness of Whole Exome Sequencing for Children with Developmental Delay in a Developing Country: A Study from Jordan

Journal of Pediatric Neurology ◽

10.1055/s-0040-1722265 ◽

2021 ◽

Author(s):

Amira Masri ◽

Hanan Hamamy

Keyword(s):

Cost Effectiveness ◽

Exome Sequencing ◽

Developmental Delay ◽

Developing Country ◽

Whole Exome Sequencing ◽

Financial Burden ◽

Indirect Costs ◽

Cost Effective ◽

Whole Exome ◽

The Cost

AbstractThis retrospective study was aiming to determine the cost effectiveness of whole exome sequencing (WES) in the diagnosis of children with developmental delay in a developing country. In this study of 40 patients, the average cost of traditional investigations and indirect costs related to rehabilitation and medications per child were USD847 and 6,585 per year, respectively. With a current cost for WES of approximately USD1,200, we concluded that performing WES could be cost effective, even in countries with limited resources, as it provides the option for genetic counseling in affected families with an ultimate reduction of overall financial burden to both parents and health care system.

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Effect of Preoperative CT Angiography Examination on the Clinical Outcome of Patients With BMI≥25.0kg/m2 Undergoing Laparoscopic Gastrectomy: Study Protocol for a Multicenter Randomized Controlled Trial

10.21203/rs.3.rs-470896/v1 ◽

2021 ◽

Author(s):

Cheng Meng ◽

Shougen Cao ◽

Xiaodong Liu ◽

Leping Li ◽

Qingsi He ◽

...

Keyword(s):

Gastric Cancer ◽

Clinical Outcome ◽

Ct Angiography ◽

Laparoscopic Gastrectomy ◽

Financial Burden ◽

Controlled Trial ◽

Second Primary ◽

Clinical Value ◽

Multicenter Randomized Controlled Trial ◽

Hospitalization Costs

Abstract Background Gastric cancer, which ranks the fifth most common malignant and causes the third oncological death, especially in east Asian countries, such as China, Japan and Korea, is still a serious global healthy issue that caused heavy financial burden for the government and family. To our knowledge, there is seldom reports of multicenter randomized control trial on the utilization of CT angiography (CTA)for the patients who are diagnosed histological gastric cancer before surgery. Therefore, we conduct this RCT to verify whether the utilization of CTA can possibly change the short- and long-term clinical outcome or not. Method: The GISSG 20 − 01 study is a multicenter, prospective, open-lable clinical study that emphasis on the application of the CTA for the patients who will undergo the laparoscopic gastrectomy to prove the clinical outcome of it. 382 patients that meet the inclusion criteria and not in accordance with exclusion criteria will be recruited in the study and randomly divided into two groups with a 1:1 ratio: CTA group(n = 191) and Non-CTA group (n = 191). Apart from both of the two groups receive the examination of upper abdomen enhanced CT, the CTA group receive the examination of CT angiography. The primary endpoint of this trial is the volume of blood loss, the second primary endpoints are retrieved number of lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3 years OS and 3 years DFS. Discussion It is anticipated that the result of this trial can provide high-level evidence and have clinical value on the application of CTA in laparoscopic gastrectomy. Trial registration: ClinicalTrials.gov, NCT04636099, Registered November 19, 2020

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Financial Toxicity in Cancer Treatment

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0077 ◽

2021 ◽

pp. 616-620

Author(s):

Victoria Blinder ◽

Francesca M. Gany

Keyword(s):

Cancer Treatment ◽

Emotional Distress ◽

Low Income ◽

Financial Distress ◽

Financial Burden ◽

Symptom Burden ◽

Indirect Costs ◽

Young Female ◽

Vulnerable Groups ◽

Financial Toxicity

Financial toxicity is a preventable cancer treatment side effect, encompassing the subjective financial distress and objective financial burden that result from increased spending and decreased earning after diagnosis. The prevalence of financial toxicity has increased with new expensive cancer treatments and insurers gradually shifting costs to patients. Patients with financial toxicity experience increased symptom burden, treatment nonadherence, and cancer-related death. The patients at highest risk are young, female, and nonwhite. For low-income patients, the indirect costs of cancer care can be especially burdensome and include child/elder care, transportation, unpaid work absences or job loss, cancer-related comorbidity treatment costs, and fulfilling dietary requirements. Psychosocial impacts include depression, emotional distress, and reduced quality of life. Patients in palliative care have rated financial distress as more severe than physical, familial, and emotional distress. Interventions and policy changes are needed to ameliorate the effects of financial toxicity, especially for the most vulnerable groups.

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The impact of beta-lactam allergy labels on hospitalized children

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.424 ◽

2020 ◽

pp. 1-7

Author(s):

Trahern W. Jones ◽

Nora Fino ◽

Jared Olson ◽

Adam L. Hersh

Keyword(s):

Length Of Stay ◽

Pediatric Patients ◽

The United States ◽

Adverse Outcomes ◽

Hospitalized Children ◽

Beta Lactam ◽

Healthcare Facilities ◽

Antibiotic Allergy ◽

Hospitalization Costs ◽

The Impact

Abstract Background and objectives: Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Method: This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs. Results: In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients. Conclusions: Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

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Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽

10.3390/medicina56020079 ◽

2020 ◽

Vol 56 (2) ◽

pp. 79

Author(s):

Ovidiu Adam ◽

Vlad Laurentiu David ◽

Florin George Horhat ◽

Eugen Sorin Boia

Keyword(s):

Closed Reduction ◽

Diagnosis Related Groups ◽

Financial Burden ◽

Treatment Options ◽

Indirect Costs ◽

Forearm Fractures ◽

Titanium Elastic Nail ◽

Fractures In Children ◽

Elastic Nail ◽

The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

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Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-036892 ◽

2020 ◽

Vol 10 (6) ◽

pp. e036892

Author(s):

Lelisa Fekadu Assebe ◽

Eyerusalem Kebede Negussie ◽

Abdulrahman Jbaily ◽

Mieraf Taddesse Taddesse Tolla ◽

Kjell Arne Johansson

Keyword(s):

Indirect Cost ◽

Economic Burden ◽

Financial Burden ◽

Household Survey ◽

Income Quintile ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Catastrophic Health Expenditures ◽

The Mean ◽

Substantial Economic Burden

ObjectivesHIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.DesignA cross-sectional survey.Setting27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.ParticipantsA total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.Outcome measuresThe economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.ResultsThe mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).ConclusionsHIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.

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