Richmond Owusu, Dakota Pritchard, Lieke Fleur Heupink, Godwin Gulbi, Brian Asare, Ivy Amankwah, Joycelyn Azeez, Martha Gyansa-Lutterodt, Lydia Dsane-Selby, Ruby Aileen Mensah, William Omane-Adjekum, Francis Ruiz, Mohamed Gad, Justice Nonvignon, Lumbwe Chola
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引用次数: 0
Abstract
Background: Childhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.
Methods: We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.
Results: In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.
Conclusion: Providing health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana's NHIS has prioritized financing for cancer treatment in children.
背景：在包括加纳在内的许多国家，儿童癌症并不是卫生保健筹资的高度优先事项。延迟就医和放弃治疗，往往是由于家庭就医的经济负担，是低收入和中等收入国家总生存率相对较低的常见原因。在这项研究中，我们分析了在加纳将医疗保险覆盖范围扩大到伯基特淋巴瘤（BL）儿童的成本效益。方法：我们在Microsoft Excel中开发了一个马尔可夫模型，以估计在提供国家健康保险计划（NHIS）时BL治疗的成本和效果，并将现状与NHIS不包括儿童癌症护理的现状进行比较。分析是从社会和卫生系统（付款人）的角度进行的。成本（以美元衡量）和效果（以残疾调整生命年（DALYs）衡量）均按3%的折现率计算。时间范围是一生。进行概率敏感性分析以评估增量成本-效果比（ICER）测量的不确定性。从国家卫生保健系统的角度进行了预算影响分析。结果：在基本病例分析中，干预（NHIS报销治疗）比目前的做法成本更低（8,302美元对9,558美元）。干预也比标准护理更有效，每位患者的DALYs更少（17.6 vs 23.33）。从社会角度来看，ICER为每个DALY避免219美元，从卫生系统角度来看，每个DALY避免113美元。概率敏感性分析表明，在进行的1000次模拟中，该干预措施可能比目前的做法成本更低，效果更好。结论：为BL患儿提供健康保险具有潜在的成本效益。这一战略的有效性和成本节约得益于其对治疗开始和维持的积极影响。根据这一证据，加纳国家卫生保健系统已经改变了政策，优先为儿童癌症治疗提供资金。
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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