Modelling Outpatients Cost of Wound Dressing in Nigeria: A Prospective Study

Background: Estimating the direct cost of wound dressing poses a challenge to patients, nurse managers, hospital administrators, health maintenance organisations and other policy makers. This study therefore model the weekly cost of wound dressing in South West NigeriaMethods: A descriptive cross sectional research design was utilized to assess the cost of wound dressing among outpatients’ clinics attendees. An inventory of direct cost of wound dressing per week consisting of cost of materials, lotion and consumables were recorded. The data collection was for period of three months in three selected Teaching Hospitals South West Nigeria. Then modelling weekly cost of wound types was done by regression analysis. The effect of various independent variables such as age, occupation, family size, monthly income, aetiology, diagnosis, wound type, comorbidities, frequency of wound dressing and health insurance coverage on cost of wound dressing per week was considered. Ethical approval was obtained from each of the hospital and Covid-19 precautions were observed.1 USD equalled ₦570Results: The estimated cost of wound dressing per week with no contribution from other variables was found to be ₦36,922- Open wound, ₦6011-Leg ulcer, ₦3768- Cancer wound, ₦2785- Diabetic Foot Ulcer, ₦610-Surgical wound. Only frequency of wound dressing was found to contribute to weekly cost of leg ulcers (P value= 0.003)Conclusions: The estimated cost of various type of wound provides yardstick for determining the weekly cost of wound dressing in Nigeria. Also, frequency of wound dressing is a major determinant of the outpatient cost of dressing. Therefore, it is imperative for nurses to render high quality wound care to match up with the huge financial commitment from patients and families

The household economic cost of caregivers: children with congenital heart diseases attending to Pediatric Hospital, Sri Lanka

Introduction Congenital heart disease is the commonest type of birth defect of which the estimated prevalence is around 8–12/1,000 worldwide. Caregivers of children with congenital heart diseases are easy victims of high economic burdens and economic instability. Objective The aim was to describe the household economic cost for a clinic visit, of primary caregivers having children with CHDs who are awaiting cardiac surgery attending a cardiology clinic at a major pediatric hospital in Sri Lanka. Methodology A descriptive cross-sectional study was conducted over three months among 427 samples of caregivers of children with congenital heart diseases at Cardiology clinic, Lady-Ridgeway Hospital Sri Lanka. A consecutive convenient sampling method was used to recruit the participant and economic cost was developed based on previous studies, surveys and opinions of an expert in economics. Results Out of caregivers, 75% were unemployed, and the median income was ₹30,000. The median direct cost per clinic visit was ₹1,800. A large proportion of direct cost was showed in traveling expenses. The median indirect cost was ₹1,000. Of the caregivers, 28.7% were falling into catastrophic expenditure during that particular month of the clinic visit. The mean waiting time per clinic visit was 53 minutes. Statistically significant association found distance with transport cost (Chi-square value = 25.14, df = 1, p & .001, OR = 3.4 (CI: 2.1–5.5). There was no statistically significant association between the income of the caregiver and expenditure (Chi-square value = 0, df = 1, p = .998, OR = 1 (CI: 0.678–1.473). Conclusions Assessment of economic burden and its associated factors is vital to recognize high-risk caregivers early, and improvement of monetary support methods.

The Research on Total Factor Productivity of Soybean in China

This paper uses the panel stochastic frontier model to study the total factor productivity of Chinese soybean. The research shows that the impact of direct cost and labor cost on yield is positive and significant, the impact of indirect cost on yield is not significant, and the impact of cash cost on yield improvement is negative.

Analisis Perbandingan Biaya Perawatan (Cost of illness Stroke Iskemik dan Stroke Hemoragik Pasien Rawat Inap di SUD Pannembahan Senopati

Stroke termasuk dalam penyakit katarostropik yang dapat mengancam jiwa, dan memiliki resiko tinggi serta membutuhan pertolongan segera. Stroke dapat menyebabkan penderitanya memiliki faktor resiko morbiditas seusia hidupnya yang dapat menimbulkan Burden disease sehingga menyebabkan kematian, cedera, hilangnya produktifitas dan membutuhkan biaya penanganan yang cukup tinggi. Tujuan utama dari penelitian ini adalah untuk mengetahui total biaya perawatan dan selisish biaya perawatan stroke iskemik dan stroke hemoragik pasien rawat inap di RSUD Panembahan Senopati Bantul. Penelitian ini menggunakan rancangan penelitian deskriptif analitik non-eksperimental dengan pendekatan cross sectional study menurut perspektif penyedia layanan kesehatan (provider). Biaya yang diperhitungkan adalah biaya langsung (direct cost) menggunakan pendekatan bottom up. Subyek penelitian adalah semua pasien stroke rawat inap yang terdaftar sebagai pasien umum di rumah sakit yang memenuhi kriteria inklusi. Data dianalisis menggunakan software Excel dan SPSS. Hasil penelitian melibatkan 50 sampel yang terdiri dari 32 pasien stroke iskemik dan 18 pasien stroke hemoragik menunjukan dengan analisis regresi linear variabel bebas berpengaruh terhadap biaya stroke sebesar 49,1%. Lama rawat inap menjadi faktor yang paling berpengaruh terhadap tingginya biaya dengan nilai p 0,00 (<0,05). Total direct health cost perawatan stroke adalah sebesar Rp151.633.600,00 Sedangkan material cost sebesar Rp113.954.918,00. Total rata-rata biaya stroke iskemik Rp4.625.511.006, stroke hemoragik Rp6.531.786.277 dengan selisih Rp1.906.275.271.

Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

Evaluation of the Direct Costs of Managing Adverse Drug Events in all Ages and of Avoidable Adverse Drug Events in Older Adults in Japan

In Japan, medical costs are increasing annually, and the increase in national medical costs, particularly in the direct cost of managing adverse drug events, is high. An in-depth understanding of these costs is important for their reduction. This study aimed to calculate the direct cost of managing adverse drug events in all ages, including older adults, and that of avoidable adverse drug events in older adults. We conducted a retrospective survey on patients aged 1 year or older who visited Gifu Municipal Hospital in Japan. We investigated and calculated the direct cost of managing adverse drug events and that of avoidable adverse drug events based on the Beers Criteria Japanese version (BCJ) and “Guidelines for medical treatment and its safety in the elderly 2015” (GMTSE-2015) in inpatients and outpatients. Among 6,504 patients, 11.1% visited the hospital or were hospitalized due to adverse drug events. The direct costs per patient with adverse drug events were 21,281 and 22,590 yen (166 and 176 euros as on September 13, 2021) for outpatients, and 853,175 and 874,582 yen (6,648 and 6,815 euros) for inpatients of all ages and older adults, respectively. The direct costs of avoidable adverse drug events per patient using drugs listed in the BCJ and GMTSE-2015 for older adults were 3,212 and 3,341 yen (25 and 26 euros) for outpatients, and 55,548 and 80,246 yen (433 and 625 euros) for inpatients, respectively. In sum, considering both inpatients and outpatients in the whole country, the direct costs of managing adverse drug events were 804.53 billion and 597.19 billion yen (6,269 million and 4,653 million euros) per year for all ages and older ages, respectively. The direct cost of avoidable adverse drug events in older adults was 83.43–258.44 billion yen (650–2,013 million euros) per year. We found that, in Japan, high medical costs are often caused by managing adverse drug events, and that the costs of avoidable adverse drug events in older adults based on the BCJ and GMTSE-2015 account for a substantial proportion of the medical cost. Therefore, by using the BCJ and GMTSE-2015, avoiding adverse drug events and reducing medical costs may be possible.

Correctional “Free Lunch”? Cost Neglect Increases Punishment in Prosecutors

Prosecutors can influence judges’ sentencing decisions by the sentencing recommendations they make—but prosecutors are insulated from the costs of those sentences, which critics have described as a correctional “free lunch.” In a nationally distributed survey experiment, we show that when a sample of (n=178) professional prosecutors were insulated from sentencing cost information, their prison sentence recommendations were nearly one-third lengthier than sentences rendered following exposure to direct cost information. Exposure to a fiscally equivalent benefit of incarceration did not impact sentencing recommendations, as predicted. This pattern suggests that prosecutors implicitly value incorporating sentencing costs but selectively neglect them unless they are made explicit. These findings highlight a likely but previously unrecognized contributor to mass incarceration and identify a potential way to remediate it.

Mass, Direct Cost and Energy Life-Cycle Cost Optimization of Steel-Concrete Composite Floor Structures

This paper presents a study showing the optimization of the mass, direct (self-manufacturing) costs, and energy life-cycle costs of composite floor structures composed of a reinforced concrete slab and steel I-beams. In a multi-parametric study, mixed-integer non-linear programming (MINLP) optimizations are carried out for different design parameters, such as different loads, spans, concrete and steel classes, welded, IPE and HEA steel profiles, and different energy consumption cases. Different objective functions of the composite structure are defined for optimization, such as mass, direct cost, and energy life-cycle cost objective functions. Moreover, three different energy consumption cases are proposed for the energy life-cycle cost objective: an energy efficient case (50 kWh/m2), an energy inefficient case (100 kWh/m2), and a high energy consumption case (200 kWh/m2). In each optimization, the objective function of the structure is subjected to the design, load, resistance, and deflection (in)equality constraints defined in accordance with Eurocode specifications. The optimal results calculated with different criteria are then compared to obtain competitive composite designs. Comparative diagrams have been developed to determine the competitive spans of composite floor structures with three different types of steel I beam: those made of welded sections and those made of IPE or HEA sections, respectively. The paper also answers the question of how different objective functions affect the amount of the calculated costs and masses of the structures. It has been established that the higher (more wasteful) the energy consumption case is, the lower the obtained masses of the composite floor structures are. In cases with higher energy consumption, the energy life-cycle costs are several times higher than the costs determined in direct cost optimization. At the end of the paper, a recommended optimal design for a composite floor system is presented that has been developed on the multi-parametric energy life-cycle cost optimization, where the energy efficient case is considered. An engineer or researcher can use the recommendations presented here to find a suitable optimal composite structure design for a desired span and uniformly imposed load.

A STUDY ON UNIT COST OF DIET IN A TERTIARY CARE GOVERNMENT HOSPITAL

Aim:To study the diet cost per meal per patient admitted in a Tertiary Care Government Hospital. Objectives:To estimate direct cost, indirect cost and total unit cost of various types of diets. Methodology: It was a cross sectional, observational and descriptive type of study conducted in a tertiary care government hospital over a period of 4 weeks. Results: It was observed that the total cost of Normal diet was ₹122.8 per day per diet and ₹130.5 per day per diet for high protein diet.