This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
Research article
Assegid G. Hellebo
University of Cape Town School of Public Health and Family Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1211-844X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa.
Methods
The primary data on service utilization were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study), a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from health system perspective were estimated in 2017 (base year) South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (US$). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis.
Results
The estimated total cost of RHD care at the tertiary hospital was US$ 2 million (in 2017 US$) for the year 2017, with surgery costs accounting for 65%. Per-patient average annual costs were US$ 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterization and heart valve surgery were the main cost drivers.
Conclusions
RHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programs at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.
Keywords
Unit cost, Cost analysis, Provider Cost, Rheumatic Fever, Rheumatic Heart Disease, Tertiary Care
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 06 Oct, 2020
No community comments so far
Editorial decision: Major revision
On 05 Jan, 2021
Review #1 received
Received 05 Dec, 2020
Review #2 received
Received 05 Dec, 2020
Reviewer #2 agreed
On 28 Nov, 2020
Reviewer #1 agreed
On 28 Nov, 2020
Reviewers invited
Invitations sent on 27 Nov, 2020
Editor assigned
On 15 Sep, 2020
Submission checks complete
On 14 Sep, 2020
Editor invited
On 14 Sep, 2020
First submitted
On 11 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Assegid G. Hellebo
University of Cape Town School of Public Health and Family Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1211-844X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 06 Oct, 2020
No community comments so far
Editorial decision: Major revision
On 05 Jan, 2021
Review #1 received
Received 05 Dec, 2020
Review #2 received
Received 05 Dec, 2020
Reviewer #2 agreed
On 28 Nov, 2020
Reviewer #1 agreed
On 28 Nov, 2020
Reviewers invited
Invitations sent on 27 Nov, 2020
Editor assigned
On 15 Sep, 2020
Submission checks complete
On 14 Sep, 2020
Editor invited
On 14 Sep, 2020
First submitted
On 11 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa.
Methods
The primary data on service utilization were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study), a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from health system perspective were estimated in 2017 (base year) South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (US$). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis.
Results
The estimated total cost of RHD care at the tertiary hospital was US$ 2 million (in 2017 US$) for the year 2017, with surgery costs accounting for 65%. Per-patient average annual costs were US$ 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterization and heart valve surgery were the main cost drivers.
Conclusions
RHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programs at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
Loading...