Modeling the likely economic cost of non-adherence to TB medicines in the Philippines

2020 ◽  
Vol 24 (9) ◽  
pp. 902-909
Author(s):  
D. Collins ◽  
H. Lam ◽  
H. Firdaus ◽  
J. Antipolo ◽  
P. Mangao
Keyword(s):  
Economic Impact ◽  
Economic Burden ◽  
Economic Cost ◽  
The Philippines ◽  
Economic Costs ◽  
Loss To Follow Up ◽  
The World ◽  
Mdr Tb ◽  
The Cost

SETTING: The Philippines has a population of over 90 million people and is one of the 22 highest TB burden countries in the world.OBJECTIVE: To understand the economic cost of non-adherence to TB medicines due to loss to follow up and stock-outs in the Philippines.DESIGN: Data were collected on the economic costs of non-adherence to TB medicines and a model was developed to show those costs under different scenarios.RESULTS: The model showed that as many as 1958 and 233 persons are likely to have died as a result of DS-TB and MDR-TB loss to follow up, respectively, and 588 persons are likely to have died as a result of TB medicine stock outs. The related economic impact in each case is likely have been to be as much as US$72.2 million, US$13.4 million and US$21.0 million, respectively.CONCLUSION: The economic costs of non-adherence to TB medicines due to loss to follow-up and stock-outs represent a significant economic burden for the country and it is likely that the cost of addressing these problems would be much less than this burden and, therefore, a wise investment.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

scholarly journals Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients

2019 ◽  
Vol 54 (1) ◽  
pp. 1800353 ◽  
Author(s):  
Ian F. Walker ◽  
Oumin Shi ◽  
Joseph P. Hicks ◽  
Helen Elsey ◽  
Xiaolin Wei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Cox Proportional Hazards Model ◽  
Serious Adverse Event ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Mdr Tb

Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.

scholarly journals Occupational Stress and Its Economic Cost in Hong Kong: The Role of Positive Emotions

2020 ◽  
Vol 17 (22) ◽  
pp. 8601
Author(s):  
Oi Ling Siu ◽  
Cary L. Cooper ◽  
Lara C. Roll ◽  
Carol Lo
Keyword(s):  
Hong Kong ◽  
Occupational Stress ◽  
Positive Emotions ◽  
Job Insecurity ◽  
Economic Cost ◽  
Economic Costs ◽  
Job Stressors ◽  
Organizational Constraints ◽  
The Cost

There has been less research on the costs of occupational stress attributed to certain job stressors in Chinese contexts. This study identified and validated common job stressors and estimated the economic cost in Hong Kong. The role of positive emotions in alleviating the economic costs of job stressors was also examined. Both qualitative and quantitative approaches were adopted. The findings obtained from five focus group discussions and a survey validated five common job stressors: Job insecurity; quantitative workload; organizational constraints; interpersonal conflicts; and work/home interface. A total of 2511 employees were surveyed, with 2032 valid questionnaires returned (925 males, 1104 females, and 3 unidentified, whose ages ranged from 18 to 70 years). The economic costs were estimated by combining the costs of absenteeism, presenteeism, and medical expenses. Absenteeism mainly caused by job stressors of the work/home interface, job insecurity, and quantitative workload accounted for an annual economic cost of HK$550 million to HK$860 million. The annual economic cost due to presenteeism mainly caused by job stressors of job insecurity, interpersonal conflict, quantitative workload, and organizational constraints ranged from HK$1.373 billion to HK$2.146 billion. The cost of medical treatments associated with occupational stress was HK$2.889 billion to HK$4.083 billion. Therefore, the total annual economic cost of occupational stress was approximately HK$4.81 billion to HK$7.09 billion. Positive emotions, representing a less explored individual factor in the cost of occupational stress studies, was found to be negatively correlated with presenteeism and buffered the negative impact of job stressors on absenteeism. The theoretical contributions and practical implications of findings are discussed.

scholarly journals THE ECONOMIC IMPACT OF NPKMg FERTILIZERS ON SMALL HOLDER COCONUTS (A Case Study in Indonesia)

CORD ◽  
1985 ◽  
Vol 1 (01) ◽  
pp. 34
Author(s):  
S. Asnawi ◽  
S.N. Darwis
Keyword(s):  
Economic Impact ◽  
The Philippines ◽  
Total Production ◽  
The World ◽  
Small Holder

Before 1939, Indonesia was the largest copra exporter in the world (FAO 1983). But since then until 1970 it was only the se­cond largest copra exporter after the Philippines (Heesch & Kuhl­mann 1982). Between 1970 and 1980 the exports of copra from Indonesia declined drastically from 184,000 tons in 1970 to only 36,000 tons in 1980, on average a decrease of about 37.6 per cent per annum for the period (Asnawi & Darwis 1984). Since 1983 Indonesia has had to stop exports of copra due to a deficit in na­tional coconut production relative to domestic needs. For example, in 1983 the total production of coconut in Indonesia was only about 2.4 million tons copra equivalent while the total consump­tion of coconut in the country in that year was about 2.48 million tons. Thus, there was a deficit in coconut production of about 80,000 tons copra equivalent in the country in that year (Asna­wi & Darwis 1984).

scholarly journals The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

2020 ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Treatment Clinic ◽  
The Status ◽  
Clinic Medical ◽  
The Cost ◽  
Lost To Follow Up ◽  
Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

Overall Economic Burden of Total Treatment Costs in Acute Myeloid Leukemia throughout the Course of the Disease

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3614-3614 ◽  
Author(s):  
Dalia Mahmoud ◽  
Barry S. Skikne ◽  
Izabela Kucmin-Bemelmans ◽  
Cathelijne Alleman ◽  
Marja Hensen
Keyword(s):  
Economic Burden ◽  
Salvage Therapy ◽  
Myeloid Leukemia ◽  
Incidence Rates ◽  
Treatment Costs ◽  
The Us ◽  
Total Treatment ◽  
The Uk ◽  
The Cost

Abstract Abstract 3614 Background: Acute Myeloid Leukemia (AML) is a common form of leukemia in adults and often requires high resource use. About 84% of the total cost is attributed to hospital payments (Menzin 2002). The aggregate disease burden is difficult to estimate due to multiple complications and treatment courses. The standard treatment modality for AML is intensive chemotherapy with complete remission (CR) achieved in up to 60% of adults with de novo AML who are less than 70 years old (Tallman, 2005), while in the older adults CR rates occur in approximately 45% (Jabbour, 2006). For patients who relapse after CR there are a limited number of efficacious therapeutic options. These include best supportive care (BSC), additional cycles of chemotherapy and stem cell transplantation (SCT) in a minority of patients. Aim: To estimate the economic burden of the total treatment costs of AML in patients receiving therapy in the US and UK. Treatment costs are specifically assessed for induction therapy (IT), consolidation therapy (CT), for follow up during CR, and salvage therapy for relapsed or refractory disease. Methods: To identify the total costs of AML therapy, a systematic literature review was conducted of standard treatments employed during the past 5 years. Economic costs were estimated per course of treatment which included IT, CT, supportive treatment during CR, and salvage therapy including use of SCT. The total economic burden was calculated combining cost per patient with epidemiology data. Incidence rates for the US and UK and treatment outcome probabilities were calculated from the Surveillance Epidemiology and End Results (SEER), Eurostat and peer reviewed literature. Unit costs were identified using publicly available databases. Calculations were conducted for younger (<65) and older (>65) patients given differences in incidence rates identified between these groups. Costs of treatment were calculated individually for each of the following treatment stages: 1) IT (standard dose chemotherapy (SDC) 1 cycle), 2) CT- 2 cycles of chemotherapy 3) follow up after CR (costs of BSC – 6 cycles), and 4) salvage therapy for relapse refractory disease. Results: The costs associated with hospitalization are the main component in all treatment stages (induction, consolidation, and relapse) ranging from 66% to 92% of the total costs. IT plus CT accounted for 19%-91% of the total cost per patient. When combining costs per patient with incidence data, it is estimated that the total economic burden of AML treatment ranges from £13 mln for population >65 and £38 mln for the <65 in the UK and approx. $0.5 billion and $1.5$ billion respectively in US. Not surprising, the cost of transplantation was the highest of all the treatments. The financial burden after relapse is also high compared to the cost of being followed in CR (which consists primarily of the laboratory monitoring and supportive care), namely £683 for BSC, £4,097 for chemotherapy and £82,262 transplantation vs. £4,097 in CR in the UK and $2,477, $56,588 and $154,739 vs. $14,861, respectively in the US. (Table 1). Summary/Conclusions: The economic burden of AML treatment is very high. In both the UK and US, hospitalization costs are the key drivers. Findings suggest that savings to the healthcare system could be achieved by sustaining CR status for longer periods. When relapse occurs, high costs are incurred again, particularly when another round of chemotherapy is given. Therefore, besides the fact that achieving and staying in CR is important from the clinical point of view, it has an essential justification from the economic perspective when considering the costs that patients incur after relapse. It is critical to focus on developing new therapies that can prevent relapse and maintain AML patients' CR status to maximize their survival. Disclosures: Mahmoud: celgene: Employment. Skikne:Celgene: Employment, Equity Ownership. Kucmin-Bemelmans:Pharmerit BV: Employment. Alleman:Pharmerit BV: Employment. Hensen:Pharmerit BV: Employment.

The Economic Cost of Suicide in Ireland

Crisis ◽  
2007 ◽  
Vol 28 (2) ◽  
pp. 89-94 ◽  
Author(s):  
Brendan Kennelly
Keyword(s):  
Gross National Product ◽  
Indirect Costs ◽  
Economic Cost ◽  
Economic Costs ◽  
Total Cost ◽  
Direct And Indirect Costs ◽  
Education And Health ◽  
Human Cost ◽  
Human Costs ◽  
The Cost

Abstract. Objective: To calculate the costs of suicide in Ireland. Method: The paper identifies all episodes of suicide in Ireland in 2001 and 2002, and projects the economic costs arising from these episodes over subsequent years. All prices have been converted to 2001 euros. Both direct and indirect costs were calculated. Indirect costs included both the cost of lost output and human costs. Results: The total cost of suicide is estimated at over Euro 906 million in 2001, and over Euro 835 million in 2002 (in 2001 prices). This is equivalent to a little under 1% of the gross national product in Ireland for those years. Conclusions: The results show that investment in health education and health promotion can be justified on the basis of the costs associated with suicide in Ireland. These costs fall on individuals, families, and society. The huge human cost of suffering associated with suicide can also be prevented through appropriate intervention to prevent death occurring. It is important that any suicide prevention strategy should include an evaluative framework to ensure that investment occurs in the areas most likely to generate the highest returns in term of suicides prevented and lives saved.

scholarly journals Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe

2021 ◽  
Author(s):  
Collin Mangenah ◽  
Definate Nhamo ◽  
Stephano Gudukeya ◽  
Emily Gwavava ◽  
Chiedza Gavi ◽  
...  
Keyword(s):  
Economic Costs ◽  
Delivery Costs ◽  
Populations At Risk ◽  
Service Efficiency ◽  
The Government ◽  
Hiv Acquisition ◽  
The Cost ◽  
The Impact ◽  
Oral Prep

AbstractAlthough oral PrEP is highly effective at preventing HIV acquisition, optimizing continuation among beneficiaries is challenging in many settings. We estimated the costs of delivering oral PrEP to populations at risk of HIV in seven clinics in Zimbabwe. Full annual economic costs of oral PrEP initiations and continuation visits were estimated from the providers’ perspective for a six-clinic NGO network and one government SGBV clinic in Zimbabwe (January–December 2018). Disaggregating costs of full initiation and incremental follow-up visits enabled modeling of the impact of duration of continuation on the cost per person-year ($pPY) on PrEP. 4677 people initiated oral PrEP, averaging 2.7 follow-up visits per person. Average cost per person initiated was $238 ($183–$302 across the NGO clinics; $86 in the government facility). The full cost per initiation visit, including central and direct costs, was $178, and the incremental cost per follow-up visit, capturing only additional resources used directly in the follow up visits, was $22. The average duration of continuation was 3.0 months, generating an average $pPY of $943, ranging from $839 among adolescent girls and young women to $1219 in men. Oral PrEP delivery costs varied substantially by scale of initiations and by duration of continuation and type of clinic. Extending the average oral PrEP continuation from 2.7 to 5 visits (about 6 months) would greatly improve service efficiency, cutting the $pPY by more than half.

scholarly journals Economic burden of eating disorders in South Korea

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sang Min Lee ◽  
Minha Hong ◽  
Saengryeol Park ◽  
Won Sub Kang ◽  
In-Hwan Oh
Keyword(s):  
Eating Disorders ◽  
South Korea ◽  
Economic Burden ◽  
Indirect Costs ◽  
Economic Cost ◽  
Medical Expenditure ◽  
Treatment Prevalence ◽  
Total Economic Cost ◽  
Total Treatment ◽  
The Cost

Abstract Background Few studies have investigated the epidemiology of eating disorders using national representative data. In this study, we investigated the treatment prevalence and economic burden of eating disorders in South Korea. Methods The aim of this study was to estimate the treatment prevalence and the medical expenditure of diagnosed eating disorders (ICD F50.x) in South Korea between 2010 and 2015. We also examined the economic costs of eating disorders, including the direct medical cost, direct non-medical costs, and indirect costs, in order to calculate the economic burden of such disorders. Results The total treatment prevalence of eating disorders in South Korea was 12.02 people (per 100,000) in 2010, and 13.28 in 2015. The cost of medical expenditures due to eating disorders increased from USD 1229724 in 2010 to USD 1843706 in 2015. The total economic cost of eating disorders was USD 5455626 in 2015. In 2015, the economic cost and prevalence of eating disorders was the highest in the 20–29 age group. Conclusions The results showed the eating disorders are insufficiently managed in the medical insurance system. Further research is therefore warranted to better understand the economic burdens of each type of eating disorder.

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