Costs of cardiovascular disease prevention care and scenarios for cost saving: a micro-costing study from rural Nigeria
Costs of cardiovascular disease prevention care and scenarios for cost saving: a micro-costing study from rural Nigeria
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DOI：
10.1097/hjh.0000000000000402
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发表时间：
2015-02-01
影响因子：
4.9
通讯作者：
Schultsz, Constance
中科院分区：
文献类型：
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作者：
Hendriks, Marleen E.;Bolarinwa, Oladimeji A.;Schultsz, Constance
目的：为了评估心血管疾病（CVD）预防保健的费用，根据国际准则，在农村尼日利亚的初级保健诊所，参加了健康保险programme.Methods：从医疗保健提供者的角度进行了一项微成本研究。每位患者每年的活动量（e. G.咨询、诊断测试）基于研究诊所的临床实践。直接（e. G.工作人员、药品）和间接费用项目（间接费用）进行了计量。队列研究、患者和工作人员观察以及研究诊所的访谈提供了患者资源利用数据。进行单变量敏感性分析。情景分析评价了各种节省费用的备选办法。主要结果是每名患者每年的心血管疾病预防保健的成本。结果：心血管疾病预防保健的成本为每名患者每年144美元（范围130-158）。直接费用为82美元，间接费用为62美元。主要的成本驱动因素是药物（39美元）和诊断检测（36美元）。高血压治疗费用为118美元（107-132），糖尿病治疗费用为263美元（236-289）。将任务从医生转移到护士，减少预约频率，最小的器官损伤筛查的组合将导致直接成本降低42%.Conclusion：这是第一项基于前瞻性收集的操作数据报告撒哈拉以南非洲地区心血管疾病预防护理成本的研究。我们的研究中观察到的成本在撒哈拉以南非洲的许多国家是负担不起的，这突出表明需要创新的融资机制来资助CVD预防护理。
Objective: To assess the costs of cardiovascular disease (CVD) prevention care according to international guidelines, in a primary healthcare clinic in rural Nigeria, participating in a health insurance programme.Methods: A micro-costing study was conducted from a healthcare provider perspective. Activities per patient per year (e. g. consultations, diagnostic tests) were based on clinical practice in the study clinic. Direct (e. g. staff, drugs) and indirect cost items (overheads) for each activity were measured. A cohort study, patient and staff observations, and interviews in the study clinic provided patient resource utilization data. Univariate sensitivity analyses were performed. Scenario analyses evaluated cost-saving options. The main outcome was the costs of CVD prevention care per patient per year.Results: The costs of CVD prevention care were United States dollars (USD) 144 (range 130-158) per patient per year. Direct costs were USD 82 and indirect costs were USD 62. The main cost drivers were drugs (USD 39) and diagnostic tests (USD 36). The costs of hypertension care were USD 118 (107-132) and that of diabetes care USD 263 (236-289) per patient per year. A combination of task-shifting from doctors to nurses, reduction of appointment frequencies, and minimal organ damage screening would result in a direct cost reduction of 42%.Conclusion: This is the first study to report the costs of CVD prevention care in sub-Saharan Africa, based on prospectively collected operational data. The costs observed in our study are unaffordable in many countries in sub-Saharan Africa, highlighting the need for innovative financing mechanisms to fund CVD prevention care.