A retrospective study assessing the clinical outcomes and costs of acute hepatitis A in Cape Town, South Africa.

Adolescent Adult Child Cost-Benefit Analysis Hepatitis A / epidemiology Humans Retrospective Studies South Africa / epidemiology Vaccination
Acute liver failure Epidemiology Health economics Hepatitis A Hepatology Immunization Vaccine preventable disease

Journal

BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551

Informations de publication

Date de publication:
11 Jan 2022
Historique:
received: 03 07 2021
accepted: 15 12 2021
entrez: 12 1 2022
pubmed: 13 1 2022
medline: 14 1 2022
Statut: epublish

Résumé

While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines. To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa. We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018. In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients [Formula: see text] 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and $563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver. More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending.

Sections du résumé

BACKGROUND BACKGROUND
While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines.
OBJECTIVES OBJECTIVE
To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa.
METHODS METHODS
We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018.
RESULTS RESULTS
In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients [Formula: see text] 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and $563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver.
CONCLUSION CONCLUSIONS
More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending.

Identifiants

DOI: 10.1186/s12879-021-06993-w PMID: 35016628 PMC: PMC8751253
pubmed: 35016628
doi: 10.1186/s12879-021-06993-w
pii: 10.1186/s12879-021-06993-w
pmc: PMC8751253
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

45

Informations de copyright

© 2022. The Author(s).

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Auteurs

Jenna Patterson (J)

Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. pttjen005@myuct.ac.za.
Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. pttjen005@myuct.ac.za.

Susan Cleary (S)

Division of Health Economics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Sheetal P Silal (SP)

Modelling and Simulatio Hub Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.

Gregory D Hussey (GD)

Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Division of Medical Microbiology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

Annabel Enoch (A)

National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.

Stephen Korsman (S)

National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.

Elizabeth Goddard (E)

Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Mashiko Setshedi (M)

Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Wendy C Spearman (WC)

Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Benjamin M Kagina (BM)

Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Rudzani Muloiwa (R)

Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › A retrospective study assessing the clinical...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › A retrospective study assessing the clinical...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › A retrospective study assessing the clinical...
questionsmedicales.fr › Organisations et économie des soins de santé › Économie › Coûts et analyse des coûts › Analyse coût-bénéfice › A retrospective study assessing the clinical...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du foie › Hépatite › Hépatites virales humaines › Hépatite A › A retrospective study assessing the clinical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A retrospective study assessing the clinical...
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questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique australe › République d'Afrique du Sud › A retrospective study assessing the clinical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Prévention primaire › Immunisation › Vaccination › A retrospective study assessing the clinical...