Estimating the cost for obstetric fistula repair in hospitals of Mozambique: a low-income country.
Cost
Mozambique
Obstetric fistula
Journal
Health economics review
ISSN: 2191-1991
Titre abrégé: Health Econ Rev
Pays: Germany
ID NLM: 101583209
Informations de publication
Date de publication:
26 Aug 2024
26 Aug 2024
Historique:
received:
18
07
2023
accepted:
24
07
2024
medline:
26
8
2024
pubmed:
26
8
2024
entrez:
26
8
2024
Statut:
epublish
Résumé
Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012-2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique. We carried out a retrospective evaluation, from the provider's perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets' costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included. The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294). Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).
Sections du résumé
BACKGROUND
BACKGROUND
Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012-2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique.
METHODS
METHODS
We carried out a retrospective evaluation, from the provider's perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets' costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included.
RESULTS
RESULTS
The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294).
CONCLUSION
CONCLUSIONS
Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).
Identifiants
pubmed: 39186146
doi: 10.1186/s13561-024-00542-2
pii: 10.1186/s13561-024-00542-2
doi:
Types de publication
Journal Article
Langues
eng
Pagination
65Informations de copyright
© 2024. The Author(s).
Références
Abza, M. W. et al. (2022) ‘Cost-effectiveness Analysis of Surgical Repair for Obstetric Fistula in Ethiopia’, (May). Available at: https://bora.uib.no/bora-xmlui/bitstream/handle/11250/3003345/Mihiret-Wake-Abza-Manuscript.pdf?sequence=1 .
BdM (2016) Relatório Anual 2015 volume 24. Available at: https://www.bancomoc.mz/fm_pgTab1.aspx?id=106&bs=1 .
Conteh L, Walker D. Cost and unit cost calculations using step-down accounting. Health Policy Plan. 2004;19(2):127–35. https://doi.org/10.1093/heapol/czh015 .
doi: 10.1093/heapol/czh015
pubmed: 14982891
Donald, S., Dominic, H. and Yvonne, A. (1998) ‘ANALYSIS OF HOSPITAL COSTS: A MANUAL FOR MANAGERS’. Available at: https://www.people.brandeis.edu/~shepard/w-manual.PDF (Accessed: 10 October 2021).
Drummond MF, et al. Methods for the Economic Evaluation of Health Care Programmes, Second Edition. Am J Prev Med. 1998;14(3):243. https://doi.org/10.1016/S0749-3797(97)00069-X .
doi: 10.1016/S0749-3797(97)00069-X
Epiu I, et al. Estimating the cost and cost-effectiveness for obstetric fistula repair in hospitals in Uganda: A low income country. Health Policy Plan. 2018;33(9):999–1008. https://doi.org/10.1093/heapol/czy078 .
doi: 10.1093/heapol/czy078
pubmed: 30252051
pmcid: 6263022
Hendriks, M. E. et al. (2014) ‘Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: A mixed methodology’, Global Health Action, 7(1). https://doi.org/10.3402/gha.v7.23573 .
Iancu, G. (2016) ‘Obstetric fistula’, Childbirth Trauma, pp. 231–247. https://doi.org/10.1007/978-1-4471-6711-2_15 .
INE (2019) ‘Resultados Definitivos: CENSO 2017 - IV Recenseamento Geral da População e Habilitação’, p. 1060. Available at: http://www.inr.pt/uploads/docs/recursos/2013/20Censos2011_res_definitivos.pdf .
INE (2021) Instituto Nacional de Estatística - Inquérito sobre Orçamento Familiar – IOF 2019/20 1. Available at: http://www.ine.gov.mz/operacoes-estatisticas/inqueritos/inquerito-sobre-orcamento-familiar/iof-2019-20/inquerito-sobre-orcamento-familiar-iof-2019-20/view .
Instituto Nacional de Saúde, I. (2022) Relatório sobre Avaliação da Estratégia Nacional de Prevenção e Tratamento de Fístulas Obstétricas, no período de 2012 à 2020.
Kande, S. et al. (2021) ‘Prevalence of Uropathogens and Their Antimicrobial Resistance Pattern among Adult Diabetic Patients’, Indian Journal of Public Health, 65(March), pp. 280–6. Available at: https://journals.lww.com/IJPH/Fulltext/2021/65030/Prevalence_of_Uropathogens_and_Their_Antimicrobial.12.aspx .
MISAU (2012) Estratégia Nacional de Prevenção e Tratamentode Fístulas Obstétricas. Available at: https://platform.who.int/docs/default-source/mca-documents/policy-documents/plan-strategy/MOZ-CC-10-07-PLAN-STRATEGY-2012-prt-ESTRATEGIA-NACIONAL-DE-PREVENCAO-DAS-FISTULAS-OBSTERICAS.pdf .
Mocumbi S, et al. Obstetric fistulae in southern Mozambique: Incidence, obstetric characteristics and treatment. Reproductive Health Reproductive Health. 2017;14(1):1–10. https://doi.org/10.1186/s12978-017-0408-0 .
doi: 10.1186/s12978-017-0408-0
MSH (2016) ‘International Medical Products Price Guide’, Management Sciences for Health, p. 443. Available at: https://www.msh.org/sites/default/files/msh-2015-international-medical-products-price-guide.pdf .
Okiria, J. C. and Kamara, R. (2016) ‘Cost of Providing Health Care Services in the Private Not for Profit Health Sector in Uganda: A Case Study of Nyenga Hospital (FY 2012/2013)’, International Journal of Science and Research (IJSR), 5(6), pp. 1333–1338. Available at: https://www.ijsr.net/archive/v5i6/NOV163618.pdf .
Polan ML, Sleemi A, B. M., M, L. and MA, M. (2016) ‘Obstetric Fistula’, Childbirth Trauma. Springer London, pp. 231–247. Available at: http://europepmc.org/books/NBK333495 (Accessed: 12 October 2021).
Portal do Governo, M. (2018) Moçambique: Mais de dois mil casos de fístulas obstetricas por ano / Notícias / Imprensa / Início - Portal do Governo de Moçambique. Available at: https://www.portaldogoverno.gov.mz/por/Imprensa/Noticias/Mocambique-Mais-de-s-mil-casos-de-fistulas-obstetricas-por-ano (Accessed: 14 October 2021).
Shepard, D. S., Hodgkin, D. and Anthony, Y. (1998) ‘Analysis of hospital costs: a manual for managers’, Institute for Health Policy, Heller School, Brandeis University, Waltham, MA, pp. 1–85. Available at: http://www.ihf-fih.org/index.php/content/download/474/3611/file/Analysis of Hospital costs a manual for managers.pdf%5Cn http://people.brandeis.edu/~shepard/w-manual.PDF .
Shepard, D. S., Hodgkin, D. and Anthony, Y. E. (2000) ‘Analysis of hospital costs: a manual for managers’, Journal of the American Medical Association. World Health Oganization - Geneva. https://doi.org/10.1001/jama.1924.02650310063032 .
Swain, D. et al. (2019) ‘Obstetric fistula: A challenge to public health’, Indian journal of public health. NLM (Medline), 63(1), pp. 73–78. Available at: https://journals.lww.com/IJPH/Fulltext/2019/63010/Obstetric_Fistula__A_Challenge_to_Public_Health.13.aspx (Accessed: 12 October 2021).
The World Bank, W. (2022) GDP per capita (current US$) - Mozambique. Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=MZ (Accessed: 12 July 2023).
UNFPA (2020) ‘OBSTETRIC FISTULA & OTHER FORMS OF FEMALE GENITAL FISTULA Guiding principles for clinical management and programme development’. Available at: https://www.unfpa.org/sites/default/files/pub-pdf/027 UF ObstetricFistulaManual_ILLUSTRATED_34-online %281%29.pdf (Accessed: 7 March 2022).
UNFPA (no date) Product Catalogue - UnfpaProcurement. Available at: https://www.unfpaprocurement.org/products . Accessed 8 Oct 2021.
Vaz, I. (2011) ‘A Fístula Obstétrica e a situação em Moçambique’. Available at: https://wlsa.org.mz/wp-content/uploads/2014/11/Fistula_Obstetrica_Vaz.pdf .
Vlassoff M, et al. The health system cost of post-abortion care in Rwanda. Health Policy Plan. 2015;30(2):223–33. https://doi.org/10.1093/heapol/czu006 .
doi: 10.1093/heapol/czu006
pubmed: 24548846
Vlassoff M, Singh S, Onda T. The cost of post-abortion care in developing countries: A comparative analysis of four studies. Health Policy Plan. 2016;31(8):1020–30. https://doi.org/10.1093/heapol/czw032 .
doi: 10.1093/heapol/czw032
pubmed: 27045001
pmcid: 5013781
Weissman, E. et al. (1999) ‘Uganda safe motherhood programme costing study’, Vasa, pp. 1–68. Available at: https://iris.who.int/bitstream/handle/10665/65984/WHO_CHS_RHR_99.9.pdf .