Cost-Effectiveness of the Ponseti Method for Treatment of Clubfoot in Pakistan
Cost-Effectiveness of the Ponseti Method for Treatment of Clubfoot in Pakistan
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DOI：
10.1007/s00268-014-2530-2
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发表时间：
2014-09-01
影响因子：
2.6
通讯作者：
Khan, Mansoor Ali
中科院分区：
文献类型：
--
作者：
Hussain, Hamidah;Burfat, Aziza Moiz;Khan, Mansoor Ali
马蹄内翻足是致残性的，发病率为0.9/1 000活产至7/1 000活产。它影响流动性、生产力和生活质量。患者使用Ponseti方法进行手术或非手术治疗。我们估计了每名患者的成本与这两种方法和这些方法的成本效益在Pakistan.Parents治疗，无论是手术或Ponseti方法，在印度河医院的免费项目马蹄内翻足的患者的父母进行了采访，2012年2月至5月。我们测量了诊断前、不完全治疗和当前治疗的直接和间接家庭支出，直到Ponseti方法的第一个支具和手术治疗患者的第一个矫正手术。医院支出由现有的账目计算，Ponseti方法的平均每位患者成本为349美元，手术治疗的患者为810美元。其中，印度河医院的费用为170美元的庞塞蒂方法和452美元的手术治疗的病人。家庭直接支出分别为154美元和314美元的Ponseti和手术方法。大部分费用发生在诊断前和治疗后，其中最大的比例用于交通、材料和服务费。Ponseti方法被证明是主要的治疗方法，增量成本效益比为1,225美元。Ponseti方法显然是在资源有限的情况下，如巴基斯坦的治疗选择。即使在提供免费诊断和治疗的项目中，治疗马蹄内翻足的家庭费用也很高，这可能是最贫困患者利用服务的障碍。
Clubfoot is disabling, with an incidence of 0.9/1,000 live births to 7/1,000 live births. It affects mobility, productivity, and quality of life. Patients are treated surgically or non-surgically using the Ponseti method. We estimated the cost per patient treated with both methods and the cost-effectiveness of these methods in Pakistan.Parents of patients treated, either surgically or with the Ponseti method, at the Indus Hospital's free program for clubfoot were interviewed between February and May 2012. We measured the direct and indirect household expenditures for pre-diagnosis, incomplete treatment, and current treatment until the first brace for Ponseti method and the first corrective surgery for surgically treated patients. Hospital expenditure was measured by existing accounts.Average per-patient cost was $349 for the Ponseti method and $810 for patients treated surgically. Of these, the Indus hospital costs were $170 the for Ponseti method and $452 for surgically treated patients. The direct household expenditure was $154 and $314 for the Ponseti and surgical methods, respectively. The majority of the costs were incurred pre-diagnosis and after inadequate treatment, with the largest proportion spent on transportation, material, and fee for service. The Ponseti method is shown to be the dominant method of treatment, with an incremental cost-effectiveness ratio of $1,225.The Ponseti method is clearly the treatment of choice in resource-constrained settings like Pakistan. Household costs for clubfoot treatment are substantial, even in programs offering free diagnostics and treatments and may be a barrier to service utilization for the poorest patients.