RESUMEN
The availability of drinking water is one of the main determinants of quality of life, disease prevention and the promotion of health. Viruses are important agents of waterborne diseases and have been described as important markers of human faecal contamination. This study aimed to investigate viruses' presence as an indicator of drinking water quality in low-income communities in the Manguinhos area, Rio de Janeiro, Brazil. Three hundred and four drinking water samples (2L/each) were collected along the drinking water distribution-to-consumption pathway in households, as well as healthcare and school units. Water samples were collected both directly from the water supply prior to distribution and after storage in tanks and filtration units. Using qPCR, viruses were detected 50 times in 45 water samples (15%), 19 of these being human adenovirus, 17 rotavirus A and 14 norovirus GII. Viral loads recovered ranged from 5E+10 to 8.7E+106 genome copies/Liter. Co-detection was observed in five household water samples and there was no difference regarding virus detection across sampling sites. Precarious and inadequate environmental conditions characterized by the lack of local infrastructure regarding basic sanitation and waste collection in the territory, as well as negligent hygiene habits, could explain viral detection in drinking water in regions with a water supply system.
Asunto(s)
Adenovirus Humanos/aislamiento & purificación , Agua Potable/virología , Gastroenteritis/virología , Norovirus/aislamiento & purificación , Rotavirus/aislamiento & purificación , Adenovirus Humanos/clasificación , Adenovirus Humanos/genética , Adenovirus Humanos/crecimiento & desarrollo , Brasil/epidemiología , Agua Potable/análisis , Gastroenteritis/economía , Gastroenteritis/epidemiología , Humanos , Higiene , Norovirus/clasificación , Norovirus/genética , Norovirus/crecimiento & desarrollo , Pobreza , Calidad de Vida , Características de la Residencia/estadística & datos numéricos , Rotavirus/clasificación , Rotavirus/genética , Rotavirus/crecimiento & desarrollo , Calidad del Agua , Abastecimiento de Agua/economíaRESUMEN
Vaccine implementation planning in low- and middle-income countries (LMIC) often focuses on children without considering special adult populations. We adapted an economic model developed by the United States Department of Defense (DoD) to evaluate the cost-effectiveness of vaccine acquisition strategies for Campylobacter-, ETEC-, Shigella-, and norovirus-associated gastroenteritis. We compared implementation costs with current medical management in the Peruvian armed forces, a special population of low- and middle-income (LMIC) adults with a high incidence of infectious gastroenteritis. Pathogen-specific vaccine implementation resulted in calculated cost-effectiveness ratio (CER) per duty day lost averted (CERDDL) of $13,741; $1,272; $301; and $803, and a CER per diarrhea day averted of $2,130; $215; $51; and $199 for Campylobacter, ETEC, Shigella, and norovirus, respectively. These estimates compare favorably to CERDDL estimates from high-income military population and suggest that implementing vaccines gastroenteritis may be cost-effective in the Peruvian military population.
Asunto(s)
Análisis Costo-Beneficio , Gastroenteritis/prevención & control , Personal Militar , Vacunas/economía , Adulto , Países en Desarrollo , Gastroenteritis/economía , Humanos , Modelos Económicos , PerúRESUMEN
Rotavirus (RV) is the main cause of acute gastroenteritis (AGE) in young children. The San Luis province of Argentina introduced RV vaccination in May 2013. We estimate vaccine impact (RVI) using real-world data. Data on all-cause AGE cases and AGE-related hospitalisations for San Luis and the adjacent Mendoza province (control group) were obtained and analysed by interrupted time-series methods. Regardless of the model used for counterfactual predictions, we estimated a reduction in the number of all-cause AGE cases of 20-25% and a reduction in AGE-related hospitalisations of 55-60%. The vaccine impact was similar for each age group considered (<1 year, <2 years and <5 years). RV vaccination was estimated to have reduced direct medical costs in the province by about 4.5 million pesos from May 2013 to December 2014. Similar to previous studies, we found a higher impact of RV vaccination in preventing severe all-cause AGE cases requiring hospitalisation than in preventing all-cases AGE cases presenting for medical care. An assessment of the economic value of RV vaccination could take other benefits into account in addition to the avoided medical costs and the costs of vaccination.
Asunto(s)
Gastroenteritis/prevención & control , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus , Enfermedad Aguda , Argentina/epidemiología , Preescolar , Análisis Costo-Beneficio , Femenino , Gastroenteritis/economía , Gastroenteritis/epidemiología , Gastroenteritis/virología , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Infecciones por Rotavirus/economía , Infecciones por Rotavirus/epidemiología , Vacunas contra Rotavirus/economía , Resultado del Tratamiento , Vacunación/economíaRESUMEN
BACKGROUND: With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. METHODS: We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. RESULTS: Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. CONCLUSIONS: The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher.
Asunto(s)
Infecciones por Caliciviridae/economía , Infecciones por Caliciviridae/prevención & control , Gastroenteritis/economía , Gastroenteritis/prevención & control , Vacunación/economía , Vacunas Virales/economía , Vacunas Virales/inmunología , Infecciones por Caliciviridae/epidemiología , Preescolar , Estudios de Cohortes , Análisis Costo-Beneficio , Países en Desarrollo , Gastroenteritis/epidemiología , Humanos , Programas de Inmunización , Lactante , Recién Nacido , Norovirus/inmunología , Perú/epidemiología , Vacunación/métodos , Vacunas Virales/administración & dosificaciónRESUMEN
BACKGROUND: Breastfeeding is vital for child survival, health, and development. Mexico has very low rates of breastfeeding and experienced a severe decrease in the prevalence of exclusive breastfeeding from 21% in 2006 to 14% in 2012. OBJECTIVE: The objective of the article was to estimate the pediatric costs of inadequate breastfeeding in Mexico associated with the following acute health conditions: respiratory infections, otitis media, gastroenteritis, necrotizing enterocolitis (NEC), and sudden infant death syndrome (SIDS). DESIGN: The authors estimated the economic costs of inadequate breastfeeding as follows: the sum of direct health care costs for diseases whose risk increases when infants are non-exclusively breastfed <6 mo or are not breastfed from ages 6 to <11 mo, lost future earnings due to premature infant death, and the costs of purchasing infant formula. Incidence cases were retrieved from national surveillance systems, except for NEC and SIDS, which were estimated from the literature. A sensitivity analysis was carried out to provide a range of costs based on different assumptions of the number of incident cases of all infant health outcomes examined. The model applied to the cohort of 1-y-old children born in 2012. RESULTS: The total annual costs of inadequate breastfeeding in Mexico for the studied cohort ranged from $745.6 million to $2416.5 million, where the costs of infant formula accounted for 11-38% of total costs. A range of 1.1-3.8 million reported cases of disease and from 933 to 5796 infant deaths per year for the diseases under study are attributed to inadequate infant breastfeeding practices; altogether these represent nearly 27% of the absolute number of episodes of such diseases. CONCLUSIONS: This study provides costs of inadequate breastfeeding that had not been quantified in Mexico. The costs presented in this article provide the minimum amount that the country should invest to achieve better breastfeeding practices.
Asunto(s)
Lactancia Materna , Desarrollo Infantil , Promoción de la Salud , Política Nutricional , Cooperación del Paciente , Adulto , Lactancia Materna/economía , Estudios de Cohortes , Costo de Enfermedad , Enterocolitis Necrotizante/economía , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/terapia , Monitoreo Epidemiológico , Femenino , Gastroenteritis/economía , Gastroenteritis/epidemiología , Gastroenteritis/mortalidad , Gastroenteritis/terapia , Costos de la Atención en Salud , Humanos , Incidencia , Lactante , Fórmulas Infantiles/economía , Mortalidad Infantil , Masculino , México/epidemiología , Encuestas Nutricionales , Otitis Media/economía , Otitis Media/epidemiología , Otitis Media/mortalidad , Otitis Media/terapia , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/mortalidad , Infecciones del Sistema Respiratorio/terapia , Muerte Súbita del Lactante/epidemiologíaRESUMEN
BACKGROUND: Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). METHODS: From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model). RESULTS: We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). CONCLUSIONS: Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.
Asunto(s)
Costo de Enfermedad , Diarrea/economía , Familia , Gastroenteritis/economía , Gastos en Salud , Pobreza , Adolescente , Adulto , Bolivia , Cuidadores , Preescolar , Estudios Transversales , Países en Desarrollo , Femenino , Hospitalización , Humanos , Renta , Lactante , Modelos Logísticos , Masculino , Oportunidad Relativa , Población Rural , Adulto JovenRESUMEN
OBJECTIVE: To describe variations in emergency department (ED) quality measures and determine the association between ED costs and outcomes for 3 pediatric conditions: asthma, gastroenteritis, and simple febrile seizure. STUDY DESIGN: This cross-sectional analysis of ED visits used the Pediatric Health Information System database. Children aged ≤ 18 years who were evaluated in an ED between July 2009 and June 2011 and had a discharge diagnosis of asthma, gastroenteritis, or simple febrile seizure were included. Two quality of care metrics were evaluated for each target condition, and Spearman correlation was applied to evaluate the relationship between ED costs (reflecting overall resource utilization) and admission and revisit rates among institutions. RESULTS: More than 250,000 ED visits at 21 member hospitals were analyzed. Among children with asthma, the median rate of chest radiography utilization was 35.1% (IQR, 31.3%-41.7%), and that of corticosteroid administration was 82.6% (IQR, 78.5%-86.5%). For children with gastroenteritis, the median rate of ondansetron administration was 52% (IQR, 43.2%-57.0%), and that of intravenous fluid administration was 18.1% (IQR, 15.3%-21.3%). Among children with febrile seizures, the median rate of computed tomography utilization was 3.1% (IQR, 2.7%-4.3%), and that of lumbar puncture was 4.0% (IQR, 2.3%-5.6%). Increased costs were not associated with lower admission rate or 3-day ED revisit rate for the 3 conditions. CONCLUSION: We observed variation in quality measures for patients presenting to pediatric EDs with common conditions. Higher costs were not associated with lower hospitalization or ED revisit rates.
Asunto(s)
Asma/economía , Asma/terapia , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Gastroenteritis/economía , Gastroenteritis/terapia , Admisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Convulsiones Febriles/economía , Convulsiones Febriles/terapia , Adolescente , Niño , Preescolar , Costos y Análisis de Costo , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Estados UnidosRESUMEN
This is the first study conducted in Grenada, with a population of approximately 108,000, to quantify the magnitude, distribution, and burden of self-reported acute gastroenteritis (AGE). A retrospective population survey was conducted in October 2008 and April 2009 and a laboratory survey from October 2008 to September 2009. The estimated monthly prevalence of AGE was 10.7% (95% CI 9.0-12.6; 1.4 episodes/ person-year), with a median of 3 days of illness. Of those who reported AGE, 31% sought medical care (stool samples were requested from 12.5%); 10% took antibiotics; 45% took non-prescribed medication; and 81% reported restricted activity. Prevalence of AGE was significantly higher among children aged <5 years (23.5%, p < 0.001). Of the AGE stool samples submitted to the laboratory for analysis, 12.1% were positive for a foodborne pathogen. Salmonella enteritidis was the most common foodborne pathogen associated with AGE-related illness. The estimated percentage of underreporting of syndromic AGE to the Ministry of Health was 69%. In addition, for every laboratory-confirmed foodborne/AGE pathogen, it was estimated that there were 316 additional cases occurring in the population. The minimum estimated cost associated with treatment for AGE was US$ 703,950 each year, showing that AGE has a potentially significant economic impact in Grenada.
Asunto(s)
Costo de Enfermedad , Diarrea/economía , Diarrea/epidemiología , Enfermedades Gastrointestinales/economía , Enfermedades Gastrointestinales/epidemiología , Abdomen Agudo , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Causalidad , Niño , Preescolar , Comorbilidad , Diarrea/terapia , Femenino , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Gastroenteritis/economía , Gastroenteritis/epidemiología , Gastroenteritis/terapia , Enfermedades Gastrointestinales/terapia , Grenada/epidemiología , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población/métodos , Prevalencia , Estudios Retrospectivos , Autoinforme , Distribución por Sexo , Factores Sexuales , Adulto JovenRESUMEN
Objectives of this study were to determine the burden and impact of acute gastroenteritis (AGE) and foodborne pathogens in Trinidad and Tobago. A retrospective, cross-sectional population survey, based on self-reported cases of AGE, was conducted in November-December 2008 and May-June 2009 (high- and low-AGE season respectively) by face-to-face interviews. From 2,145 households selected to be interviewed, the response rate was 99.9%. Of those interviewed, 5.1% (n = 110; 95% CI 4.3-6.2) reported having AGE (3 or more loose watery stools in 24 hours) in the 28 days prior to the interview (0.67 episodes/person-year). Monthly prevalence of AGE was the highest among children aged < 5 years (1.3 episodes/year). Eighteen (16%) persons with AGE sought medical care (4 treated with oral rehydration salts and 6 with antibiotics), and 66% reported restricted activity [range 1-16 day(s)]. The mean duration of diarrhoea was 2.3 days (range 2-10 days). One case submitted a stool sample, and another was hospitalized. Overall, 56 (10%) AGE specimens tested positive for foodbome pathogens. It was estimated that 135,820 AGE cases occurred in 2009 (84% underreporting), and for every 1 AGE case reported, an additional 6.17 cases occurred in the community. The estimated economic cost of AGE ranged from US$ 27,331 to 19,736,344. Acute gastroenteritis, thus, poses a huge health and economic burden on Trinidad and Tobago.
Asunto(s)
Costo de Enfermedad , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Gastroenteritis/economía , Gastroenteritis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Anciano , Causalidad , Niño , Preescolar , Comorbilidad , Estudios Transversales , Diarrea/economía , Diarrea/epidemiología , Femenino , Humanos , Lactante , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
Acute gastroenteritis (AGE) is an important public-health issue in Dominica. To determine the burden of AGE in Dominica, a retrospective, cross-sectional population survey was conducted in March-April 2009 and October 2010 (low- and-high-AGE seasons) and a laboratory survey from April 2009 to March 2010. The overall monthly prevalence of self-reported AGE was 8.6 % (95% CI 7.0-10.6); the incidence rate was 1.1 episodes/person-year and 79,157.1 episodes of AGE for the total population/year. Monthly prevalence of AGE was the highest in the 1-4 year(s) age-group (25.0%), higher in females (10.8%) and also varied by health district, with the highest monthly prevalence of AGE being reported in the Portsmouth district (13.1%). This difference in gender and across the health region was statistically significant. The estimated underreporting of syndromic AGE to the Ministry of Health was 83.3%. Furthermore, for every reported laboratory-confirmed case of AGE and foodbome disease (FBD), there was an estimated underreporting factor of 280. Overall, 47% of AGE specimens tested were positive for FBD pathogens. The predominant pathogens isolated were norovirus, followed by Giardia, Salmonella, and Shigella. The total annual estimated cost of AGE was US$ 1,371,852.92, and the total cost per capita due to AGE was US$ 19.06, indicating an economic burden of AGE-related illness on a small island of Dominica.
Asunto(s)
Costo de Enfermedad , Gastroenteritis/economía , Gastroenteritis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Estudios Transversales , Dominica/epidemiología , Femenino , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores de Tiempo , Adulto JovenRESUMEN
Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. Objective of this study was to determine the community prevalence and true burden and economic impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Guyana. A cross-sectional population-based survey was conducted in 7 of the 10 regions in Guyana during August and November 2009 to capture the high- and low-AGE season respectively. Overall, 1,254 individual surveys were administered at a response rate of 96.5%. The overall monthly prevalence of self-reported cases of AGE was 7.7% (97 cases) (95% CI 6.3-9.3), and the yearly incidence was 1.0 episodes per person-year. The highest monthly prevalence of AGE was observed in region 4 (8.9%) and in children aged 1-4 year(s) (12.7%). Of the 97 AGE cases, 23% sought medical care; 65% reported spending time at home due to their illness [range 1-20 day(s), mean 2.7 days], of whom 51% required other individuals to look after them while ill. The maximum number of stools per 24 hours ranged from 3 to 9 (mean 4.5), and number of days an individual suffered from AGE ranged from 1 to 21 day(s) (mean 2.7 days). The burden of syndromic AGE cases in the population for 2009 was estimated to be 131,012 cases compared to the reported 30,468 cases (76.7% underreporting), which implies that, for every syndromic case of AGE reported, there were additional 4.3 cases occurring in the community. For every laboratory-confirmed case of FBD/AGE pathogen reported, it was estimated that approximately 2,881 more cases were occurring in the population. Giardia was the most common foodborne pathogen isolated. The minimum estimated annual cost associated with the treatment for AGE was US$ 2,358,233.2, showing that AGE and FBD pose a huge economic burden on Guyana. Underreporting of AGE and foodbome pathogens, stool collection, and laboratory capacity were major gaps, affecting the surveillance of AGE in Guyana.
Asunto(s)
Costo de Enfermedad , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Gastroenteritis/economía , Gastroenteritis/epidemiología , Vigilancia de la Población/métodos , Características de la Residencia/estadística & datos numéricos , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Anciano , Causalidad , Niño , Preescolar , Comorbilidad , Estudios Transversales , Diarrea/economía , Diarrea/epidemiología , Femenino , Guyana/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Adulto JovenRESUMEN
Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February-7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.
Asunto(s)
Costo de Enfermedad , Gastroenteritis/economía , Gastroenteritis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Anciano , Causalidad , Niño , Preescolar , Análisis por Conglomerados , Comorbilidad , Estudios Transversales , Diarrea/economía , Diarrea/epidemiología , Femenino , Enfermedades Transmitidas por los Alimentos/economía , Enfermedades Transmitidas por los Alimentos/epidemiología , Humanos , Lactante , Entrevistas como Asunto/métodos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia de la Población/métodos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Adulto JovenRESUMEN
OBJECTIVE: To gather and calculate utilities for a wide range of health states in the pediatric population. STUDY DESIGN: The study subjects, parents or guardians at least 18 years of age with at least 1 child under age 18 years, were recruited through our Pediatric Research Network (PResNet). Recruitment locations included pediatric clinics, the Indiana State Fair, and public and private conventions. Each subject's utilities were assessed on 3 random health states out of 29 chosen for the study. Both the time trade-off and standard gamble methods were used to measure utilities. RESULTS: Utilities were assessed in a total of 4016 participants (a recruitment rate of 88%). Utility values ranged from a high for acute otitis media (0.96 by standard gamble; 0.97 by time trade-off) to a low for severe mental retardation (0.59 by standard gamble; 0.51 by time trade-off). CONCLUSIONS: Our extensive data set of utility assessments for a wide range of disease states can aid future economic evaluations of pediatric health care.
Asunto(s)
Técnicas de Apoyo para la Decisión , Estado de Salud , Evaluación de Resultado en la Atención de Salud , Padres , Años de Vida Ajustados por Calidad de Vida , Adulto , Asma/economía , Trastorno por Déficit de Atención con Hiperactividad/economía , Ceguera/economía , Parálisis Cerebral/economía , Niño , Epilepsia/economía , Femenino , Gastroenteritis/economía , Pérdida Auditiva/economía , Hospitalización , Humanos , Hipersensibilidad/economía , Discapacidad Intelectual/economía , Masculino , Otitis Media/economía , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$ 7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio.
Asunto(s)
Gastroenteritis/economía , Infecciones por Rotavirus/economía , Vacunas contra Rotavirus/economía , Brasil , Preescolar , Estudios de Cohortes , Análisis Costo-Beneficio/estadística & datos numéricos , Femenino , Gastroenteritis/prevención & control , Humanos , Lactante , Masculino , Rotavirus/efectos de los fármacos , Infecciones por Rotavirus/prevención & controlRESUMEN
OBJECTIVE: To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina, Brazil, Chile, Dominican Republic, Honduras, Mexico, Panama, and Venezuela). METHODS: An economic model was constructed using epidemiological data from published articles, national health administration studies, and country-specific cost estimates. For each of the eight countries, the model estimated the rotavirus outcomes for the 2003 birth cohort during the first five years of life. The main outcome measures included health care costs, transportation costs, lost wages, and disease burden expressed in disability-adjusted life years. Estimates were expressed in 2003 US dollars. All future costs and disability-adjusted life year estimates were discounted at a rate of 3 percent. Sensitivity analyses evaluated the impact of specific variables on the medical cost of treating rotavirus. RESULTS: For every 1 000 children born during 2003 in the eight Latin American and Caribbean countries studied here, we estimated that rotavirus gastroenteritis would result in an average of 246 outpatient visits, 24 hospitalizations, 0.6 deaths, and US$ 7 971 in direct medical costs during their first five years of life. The incidence of rotavirus-associated outpatient visits and the cost of outpatient visits were predicted to have the largest impact on the total medical cost per child. CONCLUSIONS: Rotavirus gastroenteritis is likely to result in substantial disease and economic burden to health systems in Latin American and Caribbean countries, and the foreseeable burden should be an important consideration in evaluating the cost-effectiveness of vaccination.
OBJETIVO: Estimar la carga económica y de morbilidad de la gastroenteritis por rotavirus en hospitales y servicios ambulatorios de ocho países de América Latina y el Caribe (Argentina, Brasil, Chile, Honduras, México, Panamá, República Dominicana y Venezuela). MÉTODOS: Se elaboró un modelo económico a partir de datos epidemiológicos de artículos publicados, estudios de autoridades sanitarias nacionales y los estimados de costos específicos de cada país. El modelo calculó las consecuencias de la infección por rotavirus en los primeros cinco años de vida de la cohorte de nacidos en 2003 en cada uno de los ocho países estudiados. Las principales medidas de valoración fueron los costos de la atención sanitaria, los costos de transportación, los salarios perdidos y la carga de morbilidad expresada en años de vida ajustados por discapacidad. Los estimados se expresaron en dólares estadounidenses del año 2003. Se empleó una tasa de descuento de 3 por ciento para los cálculos de costos y años de vida ajustados por discapacidad de los años siguientes. El impacto de las variables específicas sobre los costos clínicos del tratamiento de la infección por rotavirus se realizó mediante análisis de sensibilidad. RESULTADOS: Se estimó que durante los primeros cinco años de vida, la gastroenteritis por rotavirus provoca en promedio 246 consultas externas, 24 hospitalizaciones, 0,6 muertes y gastos médicos directos por US$ 7 971,00 por cada 1 000 niños nacidos en 2003 en los ocho países estudiados de América Latina y el Caribe. Se prevé que la frecuencia de visitas médicas asociadas con la infección por rotavirus y los costos por consultas externas tengan el mayor impacto en los costos clínicos totales por niño. CONCLUSIONES: La gastroenteritis por rotavirus puede representar una considerable carga económica y de morbilidad para los sistemas sanitarios de los países de América Latina y el Caribe. Se debe prestar una especial atención a la carga previsible al evaluar la efectividad en función del costo de la vacunación contra rotavirus.
Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Costo de Enfermedad , Gastroenteritis/economía , Gastroenteritis/virología , Costos de la Atención en Salud , Infecciones por Rotavirus/economía , Región del Caribe , Estudios de Cohortes , América Latina , Modelos EconómicosRESUMEN
OBJECTIVES: To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina, Brazil, Chile, Dominican Republic, Honduras, Mexico, Panama, and Venezuela). METHODS: An economic model was constructed using epidemiological data from published articles, national health administration studies, and country-specific cost estimates. For each of the eight countries, the model estimated the rotavirus outcomes for the 2003 birth cohort during the first five years of life. The main outcome measures included health care costs, transporation cost, lost wages, and disease burden expressed in disability-adjusted life years. Estimates were discounted at a rate of 3 percent. Sensitivity analyses evaluated the impact of specific variables on the medical cost of treating rotavirus. RESULTS: For every 1000 children born during 2003 in the eight Latin American and Caribbean countries studied here, we estimated that rotavirus gastroenteritis would result in an average of 246 outpatient visits, 24 hospitalizations, 0.6 deaths, and US$7971 in direct medical costs during their first five years of life. The incidence of rotavirus-associated outpatient visits and the cost of outpatient visits were predicted to have the largest impact on the total medical cost per child. CONCLUSIONS: Rotavirus gastroenteritis is likely to result in substantial disease and economic burden to health systems in Latin America and Caribbean countries, and the foreseeable burden to health systems in Latin America and Caribbean countries, and the foreseeable burden should be important an consideration in evaluating the cost-effectiveness of vaccination (AU)
Asunto(s)
Humanos , Preescolar , Niño , Gastroenteritis , Infecciones por Rotavirus/economía , Rotavirus , Gastroenteritis/economía , América Latina , Costos y Análisis de Costo/economía , Costos y Análisis de Costo/estadística & datos numéricos , Costo de Enfermedad , Región del CaribeRESUMEN
This is a prospective 12 month (July 2003-June 2004) cohort study in one large tertiary hospital of Santiago, Chile aimed to describe clinic features and calculate the direct costs of hospitalization associated to community-acquired (n = 78) and nosocomially-acquired (n = 52) rotavirus infection. A gastroenteritis severity score after Rennels 1996, (0 to 17 points) was applied and costs where calculated based on those assigned by the Chilean National Funds for Health (FONASA). Severe gastroenteritis manifested by a score > 14 occurred in 26.9% and 9.6% of community and nosocomially-acquired cases respectively (p < 0.015). The former had lower bicarbonate levels (p < 0.001), and required more volume expansion compared to the latter (p < 0.023). The average cost was US 277 per case for community acquired rotavirus and US 268 for nosocomial infection. In this hospital the cost of nosocomial rotavirus infection was approximately 13,900 US dollars for a 12 month period. These results should stimulate the implementation of active prevention and control programs.