Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis.
Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis.
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卢旺达一个农村地区乳腺癌早期诊断项目的卫生系统成本：一项回顾性横断面经济分析
DOI：
10.1136/bmjopen-2022-062357
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发表时间：
2022-06-30
期刊：
影响因子：
2.9
通讯作者：
Pace, Lydia E.
中科院分区：
文献类型：
--
作者：
Nambaziira, Rashidah;Niteka, Lysa Carolle;Dusengimana, Jean Marie Vianney;Ruhumuriza, John;Bhangdia, Kayleigh Pavitra;Mugunga, Jean Claude;Uwineza, Marie Louise;Rugema, Vestine;Erfani, Parsa;Shyirambere, Cyprien;Shulman, Lawrence N.;Rabideau, Melany;Pace, Lydia E.
本研究旨在量化卢旺达一个农村地区乳腺癌早期检测（BCED）项目前两年的卫生系统成本。我们还旨在估算在具有不同转诊途径的其他地区实施该项目的成本，并确定提高成本效益的机会。
基于时间驱动的作业成本法进行回顾性横断面分析，依据定时的患者临床诊疗情况、回顾性患者数据以及从行政和财务记录中提取的资源单位成本。
BCED项目侧重于对有乳腺症状的个体进行及时评估。该研究评估了布雷拉区的七个卫生中心（HCs）以及布塔罗区医院的布塔罗癌症卓越中心（BCCOE）的BCED项目的卫生系统成本。
对每次患者就诊的卫生系统成本以及每例确诊癌症的成本进行了量化。还估算了总的启动成本和经常性运营成本，以及在其他地区不同规模扩大调整的卫生系统成本。
两年内一次性启动成本为36917美元，经常性运营成本为67711美元，临床成本为14824美元。卫生中心的临床乳腺检查（CBE）每次就诊成本为3.27美元。在BCCOE，仅进行CBE的就诊每次成本为13.47美元，CBE/超声检查每次成本为14.79美元，CBE/超声检查/活检/病理检查每次成本为147.81美元。总体而言，每例确诊乳腺癌的临床成本为1482美元。临床成本的驱动因素是卫生中心的人员（55%）和BCCOE的活检/病理检查用品（46%）。在其他地区，患者的乳腺评估路径更长，每位患者约增加14.00美元；如果超声服务分散化，这一成本可以降低。
卫生中心与BCED服务相关的临床成本适中，与其他普通门诊服务相似。BCED项目的启动和运营成本较高，但通过使用当地培训人员和虚拟指导可以降低。在其他地区，将超声和/或活检服务分散到区医院可以降低成本。
This study aimed to quantify the health system cost of the first 2 years of a Breast Cancer Early Detection (BCED) programme in a rural district in Rwanda. We also aimed to estimate the cost of implementing the programme in other districts with different referral pathways and identify opportunities for enhanced cost efficiency. Retrospective, cross-sectional analysis using time-driven activity-based costing, based on timed patient clinical encounters, retrospective patient data and unit costs of resources abstracted from administrative and finance records. The BCED programme focused on timely evaluation of individuals with breast symptoms. The study evaluated the health system cost of the BCED programme at seven health centres (HCs) in Burera district and Butaro Cancer Centre of Excellence (BCCOE) at Butaro District Hospital. Health system costs per patient visit and cost per cancer diagnosed were quantified. Total start-up and recurring operational costs were also estimated, as well as health system costs of different scale-up adaptations in other districts. One-time start-up costswere US$36 917, recurring operational costswere US$67 711 and clinical costswere US$14 824 over 2 years. Clinical breast examinations (CBE) at HCs cost US$3.27/visit. At BCCOE, CBE-only visits cost US$13.47/visit, CBE/ultrasound US$14.79/visit and CBE/ultrasound/biopsy/pathology US$147.81/visit. Overall, clinical cost per breast cancer diagnosed was US$1482. Clinicalcost drivers were personnel at HCs (55%) and biopsy/pathology supplies at BCCOE (46%). In other districts, patients experience a longer breast evaluation pathway, adding about US$14.00/patient; this could be decreased if ultrasound services were decentralised. Clinical costs associated with BCED services at HCs were modest, similar to other general outpatient services. The BCED programme’s start-up and operational costs were high but could be reduced by using local trainers and virtual mentorship. In other districts, decentralising ultrasound and/or biopsies to district hospitals could reduce costs.
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影响因子：
2.8
作者：
Lopes, Lygia Vieira;Miguel, Fernando;Santos, Lucio Lara
通讯作者：
Santos, Lucio Lara
影响因子：
2.3
作者：
Odhiambo, Jackline;Ruhumuriza, John;Hedt-Gauthier, Bethany L.
通讯作者：
Hedt-Gauthier, Bethany L.
影响因子：
6.2
作者：
Yip, Cheng-Har;Smith, Robert A.;Shastri, Surendra
通讯作者：
Shastri, Surendra
影响因子：
3.1
作者：
Ruhumuriza J;Odhiambo J;Riviello R;Lin Y;Nkurunziza T;Shrime M;Maine R;Omondi JM;Mpirimbanyi C;de la Paix Sebakarane J;Hagugimana P;Rusangwa C;Hedt-Gauthier B
通讯作者：
Hedt-Gauthier B
影响因子：
--
作者：
Pace, Lydia E.;Dusengimana, Jean Marie Vianney;Mpunga, Tharcisse
通讯作者：
Mpunga, Tharcisse