Health Payment Research Articles

Comparative impact of Covid-19 and common diseases on poverty in Cameroon and sustainable response strategies

In the context of a developing country like Cameroon characterized by the scarcity of financial resources and the appearance of Covid-19, this article shows that this pandemic was not more important than the pre-existing health problems to the point of giving it more importance in funding compared to strengthening the health system. The theoretical elasticity model of the poverty rate to growth is used to estimate the impact of Covid-19 and the incidence of impoverishing health expenditure is used for the impact of common diseases. It is estimated through direct health payments that common diseases push about 340,865 people into extreme poverty annually. The Covid-19, through the loss of growth generated between 4.8 and 6.6 points according to the optimistic or pessimistic scenarios, would impoverish between 224,193 and 398,565 people: impact on the number of poor ranging from 0.7 to 1.2 times that of all common diseases, i.e., equivalent on average, but sensitive to the speed of spread of the virus and the duration of the crisis while the impact of common diseases is structural and linked to the poorly performing health system. The solutions proposed are endogenous and linked to the impact mechanisms.

Comparison of the Distribution of Household Financial Contributions to the Health System before and during COVID-19 Outbreak: Evidence from Nationwide Survey in Iran.

Health and economy has substantially been influenced by the coronavirus disease 2019 (COVID-19) pandemic. Because of these impacts, household financial contribution to health system is likely to be changed. This study aimed to compare the distribution of household financial contributions before and during the COVID-19 epidemic. This is a cross-sectional study. The data were obtained from Iran's Households Income and Expenditure Survey as a national representative survey and included 38,328 households in 2019 (before COVID-19) and 37,577 households in 2020 (during COVID-19 pandemic). The household expenditures deflated according to the Consumer Price Index. The indices of households' out-of-pocket Payments (OPP), catastrophic health expenditures (CHE), and impoverishment were calculated based on a standard methodology. Data analysis was done using an Excel-based software. The households' total expenditures declined for both urban and rural areas during the COVID-19 outbreak. Meanwhile, health expenditure experienced a negative growth rate for urban and rural households at -25.75% and -15.47%, respectively. The average per capita of OOP annually was 1,220,416 ($41.086 PPP) Rials for urban households and 1,017,760 Rials ($34.263 PPP) for rural households in 2020 (the era of COVID-19), which had dropped -30% and -16%, respectively, relative to 2019 (before COVID-19). The proportional share of health service types from the total health expenditure did not change importantly after the onset of COVID-19. The incidence of CHE and impoverishment due to health payments reduced after the onset of COVID-19. The households' health expenditures changed considerably during the COVID-19 pandemic and these changes were the same for the urban and rural areas. Despite COVID-19 multi-faceted shocks, the findings of this study showed a slight decline in the incidence of CHE and impoverishment caused by health expenditures. It might be due to forgone health services during the COVID-19 pandemic. Data from these household surveys have some limits to depicting the real effects of this crisis.

The impact of health reform on poverty estimates in Iran: Implications for monitoring the first goal of Sustainable Development Goals.

Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011-2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs). The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $). Our results indicate that the incidence of impoverishing health expenditures has remainedrelatively low during 2011-2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016. Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro-poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter-sectoral approach.

Improving Diabetes Care Through Population Health Innovations and Payments: Lessons from Western Maryland.

Global budgets might incentivize healthcare systems to develop population health programs to prevent costly hospitalizations. In response to Maryland's all-payer global budget financing system, University of Pittsburgh Medical Center (UPMC) Western Maryland developed an outpatient care management center called the Center for Clinical Resources (CCR) to support high-risk patients with chronic disease. Evaluate the impact of the CCR on patient-reported, clinical, and resource utilization outcomes for high-risk rural patients with diabetes. Observational cohort study. One hundred forty-one adult patients with uncontrolled diabetes (HbA1c > 7%) and one or more social needs who were enrolled between 2018 and 2021. Team-based interventions that provided interdisciplinary care coordination (e.g., diabetes care coordinators), social needs support (e.g., food delivery, benefits assistance), and patient education (e.g., nutritional counseling, peer support). Patient-reported (e.g., quality of life, self-efficacy), clinical (e.g., HbA1c), and utilization outcomes (e.g., emergency department visits, hospitalizations). Patient-reported outcomes improved significantly at 12 months, including confidence in self-management, quality of life, and patient experience (56% response rate). No significant demographic differences were detected between patients with or without the 12-month survey response. Baseline mean HbA1c was 10.0% and decreased on average by 1.2 percentage points at 6 months, 1.4 points at 12 months, 1.5 points at 18 months, and 0.9 points at 24 and 30 months (P<0.001 at all timepoints). No significant changes were observed in blood pressure, low-density lipoprotein cholesterol, or weight. The annual all-cause hospitalization rate decreased by 11 percentage points (34 to 23%, P=0.01) and diabetes-related emergency department visits also decreased by 11 percentage points (14 to 3%, P=0.002) at 12 months. CCR participation was associated with improved patient-reported outcomes, glycemic control, and hospital utilization for high-risk patients with diabetes. Payment arrangements like global budgets can support the development and sustainability of innovative diabetes care models.

Comparing pharmaceutical company payments in the four UK countries: a cross-sectional and social network analysis

ObjectivesTo examine the characteristics of pharmaceutical payments to healthcare and patient organisations in the four UK countries. Compare companies spending the most; types of organisations receiving payments and types of...

Assessing Lesotho's Financial Burden of Household Payments and Access to Healthcare, 2022

Background: Health care financing is primarily about paying for health care. It motivates health care providers to increase the supply of health care goods and services to ensure that all individuals have access to effective public health and personal health care services and goods. The ultimate intent is to improve the health of individuals and the general population in line with the principles of Universal Health Coverage. When patients’ OOP reaches a certain level, some people forgo health care due to the price, and others who access services face financial difficulties. Objective: The specific objective of the present study is to determine access to essential health services by households and the financial burden posed as a result of their intent to utilize theses services. Methods: The paper uses data from the national household income and expenditure survey (2018/19). It provides an insight into the health care expenditure and evidence on whose health service needs the health system meets and the household financial burden by health payments. Results: Out-of-pocket health expenditure (OOP) as a share of total health expenditure on average stands at 11.1% in 2018/19. About 3.3 % of households or 4,295 households that corresponds to about 17,180 individuals spend 52.1 % of their net of food income (non-subsistence income) on healthcare – a catastrophic level of household spending. Conclusion: Despite the low rate of out-of-pocket investing by families, and moderately expanding domestic investing in health care, Lesotho health care system requires a combination of policies to ensure fair financing of health care.

Incremental net monetary benefit of biologic therapies in moderate to severe asthma: a systematic review and meta-analysis of economic evaluation studies

Objectives This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma. Methods We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6–11 years). Heterogeneity was assessed using the I2 statistic. Results A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP (n = 8, INB, −6,341 (95% CI, -$25,000 to $12,210), I2=86.18%) and SP (n = 5, -$14,000 (-$170,000 to $140,000), I2=75.64%). A similar finding was observed in those aged 6–11 years from the HCPP in LMICs (n = 2, -$45,000 (-$73,000 to $17,000), I2=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity. Conclusion The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.

Cost-utility analysis of radiofrequency ablation versus optimal medical therapy in managing supraventricular tachycardia among Filipinos.

Radiofrequency ablation (RFA) is the standard of care in the management of supraventricular tachycardia (SVT). Its cost-effectiveness in an emerging Asian country has not been studied. A cost-utility analysis of RFA versus optimal medical therapy (OMT) among Filipinos with SVT was conducted using the public healthcare provider's perspective. A simulation cohort using a lifetime Markov model was constructed using patient interviews, a review of literature, and expert consensus. Three basic health states were defined: stable, SVT recurrence, and death. The incremental cost per quality-adjusted life year (ICER) was determined for both arms. Utilities for the entry states were derived from patient interviews using the EQ5D-5L tool; utilities for other health states were taken from publications. Costs were assessed from the healthcare payer perspective. A sensitivity analysis was done. Base case analysis showed that RFA versus OMT is both highly cost-effective at 5 years and over a lifetime. RFA at 5 years costs about PhP276,913.58 (USD5,446) versus OMT of PhP151,550.95 (USD2,981) per patient. Discounted lifetime costs were PhP280,770.32 (USD5,522) for RFA, versus PhP259,549.74 (USD5,105) for OMT. There was improved quality of life with RFA (8.1 vs. 5.7 QALYs per patient). The 5-year and lifetime incremental cost-effectiveness ratios were PhP148,741.40 (USD2,926) and Php15,000 (USD295), respectively. Sensitivity analysis showed 56.7% of simulations for RFA fell below a GDP-benchmarked willingness-to-pay (WTP) threshold. Despite the initial higher cost, RFA versus OMT for SVT is highly cost-effective from the Philippine public health payer's perspective.

Why do People Avoid Visiting Specialist Doctors? Answers from a Developing Country: Turkey Case

Avoid seeking medical care deemed necessary has severe negative effects on health. Indeed, delayed presentation of patients puts a significant burden on healthcare costs. There is limited literature examining the avoidance behaviour of people. Our study explores the reasons for avoiding considering the Turkey case. TurkStat’s health research survey 2012 data is employed to examine why people avoid visiting the specialist doctor when needed to consult a specialist for healthcare service. Descriptive statistics analysis is conducted. It is seen that among 28,056 respondents 12.6% were avoiders. Compared to non-avoiders, avoiders were more likely to be female, to live in rural area, to make out-of-pocket health payments, to be illiterate and to have low income. Indeed, the avoiders were more likely to have worse perceived health, negative emotions, mental disorders, serious health problems and chronic diseases. It is found that for approximately one-third of avoiders’ the main reason for avoiding was high costs. 22% of the avoiders reported that they could not take time. The other avoiding reasons were organisational factors, fear of medical treatment/surgery, distance/transportation, late appointment dates, having nobody to accompany and non-supportive family/relatives. In Turkey, interventions combating healthcare avoidance behaviours in at-risk populations should be developed.

In Ethiopia's Kutaber district, does community-based health insurance protect households from catastrophic health-care costs? A community- based comparative cross-sectional study.

Every health system needs to take action to shield households from the expense of medical costs. The Ethiopian government implemented community-based health insurance (CBHI) to protect households from catastrophic health care expenditure (CHE) and enhance the utilization of health care services. The impact of CBHI on CHE with total household expenditure and non-food expenditure measures hadn't been studied, so the study aimed to evaluate the impact of CBHI on CHE among households in Kutaber district, Ethiopia. A total of 472 households (225 insured and 247 uninsured) were selected by multistage sampling techniques. Households total out-of-pocket (OOP) health payments ≥10% threshold of total household expenditure or ≥40% threshold of household non-food expenditure categorized as CHE. The co-variants for participation in the CBHI scheme were estimated by using a probit regression model. A propensity score matching analysis was used to determine the impact of CBHI on CHE. A Chi-square (χ2) test was computed to compare CHE between insured and uninsured households. The magnitude of CHE was 39.1% with total household expenditure and 1.8% with non-food expenditure measures among insured households. Insured households were 46.3% protected from CHE when compared to uninsured households with total household expenditure measures and 24.2% to 25% with non-food expenditure measures. The magnitude of CHE was lower among CBHI-enrolled households. CBHI is an effective means of financial protection benefits for households as a share of total household expenditure and non-food expenditure measures. Therefore, increasing the upper limits of benefit packages, minimizing exclusions, and CBHI scale-up to uninsured households is essential.

Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients

BackgroundRehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer’s perspective, and public healthcare and long-term care payerʼs perspective in Japan.MethodsCost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis.ResultsThe ICER was $6339/QALY from public health payer’s perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payerʼs perspective. The result of sensitivity analysis confirmed the results.ConclusionThe results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.

Implementing HL7 FHIR

Fast Healthcare Interoperability Resources (FHIR), created by HL7 more than a decade ago, has become a global standard for exchanging data. Communities of interest have organized under the HL7 FHIR Accelerator Program to develop implementation guides and applications for patient care, health payment systems, public health, patient engagement, clinical and basic research, and social determinants of health. Despite efforts to coordinate the creation of applications in an ever-increasing diversity of use cases, there have been challenges to ensure semantic interoperability, security, privacy, consistent interpretation of the specifications, and the workforce capacity across the industry. In response to these challenges, HL7 created the Standards Implementation Division with the aims of developing a unique ecosystem for continuous testing and discovery, building a global education and certification program, and facilitating advancement across the diverse FHIR implementation communi

Health Services for Health Social Security Administrative Body Participants at the Hingk Health Center, West Papua Province, Indonesia

Background: To improve services for members of the Social Security Administrative Body at the Hingk Community Health Center in West Papua Province, it is highly hoped that the leadership of the Community Health Center can improve services for participants of the Health Social Security Administering Body. This study aims to obtain information about the services of members of the Health Social Security Administration at the Hingk Community Health Center, West Papua Province, Indonesia. Subjects and Method: This study uses a qualitative descriptive approach. In this study, the authors used two key informants and main informant to dig for indepth information related to health services in terms of waiting time, health service facilities and payment mechanisms for members of the Social Security Administering Body in the working area of the Hingk Health Center. The instrument used by researchers in collecting data is the researchers themselves. The types of data and data sources that the researchers will collect in this study consist of primary data and secondary data. Data collection techniques were carried out through observation, in-depth interviews and documentation. While the stages of qualitative data analysis were carried out by researchers with three stages of the process, namely data reduction, data categorization, and data interpretation. Results: The results of the study illustrate that the level of service for members of the Social Security Administering Body at the Hingk Community Health Center in West Papua Province, waiting time, and facilities are still relatively low for services for participants of the Health Social Security Administering Body. This was revealed during in-depth interviews that most of the patients of the Health Social Security Administering Body waited a long time to be examined, and patients were dissatisfied with the facilities provided by health workers. Conclusion: The long waiting time for patient examinations would cause complaints from patients and the lack of availability of facilities provided by the Public Health Center would cause patients to feel less satisfied with the services provided. Keywords: waiting time, service facilities, financing mechanisms

Decomposed Trends of Iranian Private Health Expenditures: Should Inequality be Appreciated?

Background: Inequalities in health and health care have drawn considerable attention in social determinants of health literature. This study aims to calculate the inequality of out-of-pocket health payments (OPHP) for Iranian households during the period 1984 to 2019 and provide decomposed inequality for households with different socioeconomic status. Methods: This longitudinal study utilized the Iranian Statistics Centre data on Iranian household income and expenditures survey. The analysis includes a total of 995,300 households during a 36-year period from 1984 to 2019. The Theil index and the mean logarithmic deviation were used to decompose inequality into within-group and between-group for OPHP among Iranian households. Results: The findings indicate that the mean of the Theil index for the households covered by insurance is 1.44 (SD ± 0.34), while the index was 1.35 (SD ± 0.31) for households without insurance coverage. The mean of the Theil index for rural and urban households was 1.29 (SD ± 0.29) and 1.43 (SD ± 0.33), respectively. Regardless of the fluctuations, the trends of between- group and within group inequalities in OPHP were almost similar until 2011, but they followed a different path since then. Conclusion: Households living in cities, households with insurance coverage, and households in high income levels have experienced more inequality in OPHP than other households. This study provides a novel interpretation of inequality in health care expenditures and provides a long-term time series data to assess the effectiveness of implemented policies in health care system.

ANTIPSYCHOTIC MEDICATION USE IN ASSISTED LIVING/RESIDENTIAL CARE: DO ORGANIZATIONAL CHARACTERISTICS MATTER?

Abstract This study investigates how assisted living/residential care (AL/RC) and memory care (MC) contexts are associated with the prevalence of antipsychotic medication use (APU). Primary data were collected from a statewide representative sample of AL/RC settings through the Oregon Community-Based Care study from 2017-2019 and combined with publicly available administrative data. Framed by Donabedian’s model of care quality, we examine associations among 90-day prevalence of APU, organizational, care process, and AL/RC resident population characteristics using random intercepts regression models. Every licensed AL/RC setting in Oregon receives an annual mailed survey to provide aggregate resident demographics, health acuity, health service use, payment type and organizational policies. Organizational measures (e.g., profit status, license type, geographic designation) were collected from state websites. The average 90-day prevalence of APU among all Oregon AL/RC settings is 30.7%, though rates differ by MC endorsement (23.9% in AL/RC and 42.7% in MC). Compared to care processes and resident population characteristics, organizational characteristics were associated with larger magnitudes of difference in rates of APU. Nonprofit settings were associated with lower rates of APU in both AL/RC (β= -4.4 percentage points, [95% CI: -8.4, -0.4]) and MC (β= -12.4, [95% CI: -21.2, -3.6]. Compared to low-Medicaid settings, settings with very high proportions of Medicaid residents were associated with higher prevalence of APU, +8.9 in AL/RC (95% CI: 1.7, 16.1) and +11.0 in MC (95% CI: 2.3, 19.8). Policymakers might consider how organizational resource capacity influences APU in AL/RC settings, especially if APU prevalence is treated as a quality indicator.

Cost-utility analysis of emicizumab for the treatment of severe hemophilia A patients in Canada.

EHL FVIII products and emicizumab provide clinicians with other prophylactic options for treating hemophilia A, however, it is unclear if emicizumab is a cost-saving option. The objective of this study is to estimate the health and economic effects of using prophylactic EHL FVIII, SHL FVIII, and emicizumab in severe haemophilia A patients. A state-transition Markov model evaluated the cost-effectiveness of prophylactic SHL FVIII, EHL FVIII, and emicizumab in a cohort of 2-year-old male patients over a lifetime horizon in the form of a cost-utility analysis using a Canadian provincial ministry of health payer perspective. The transition probabilities, costs, and utilities were obtained from literature and the Canadian Bleeding Disorders Registry. Probabilistic sensitivity and scenario analyses were performed to test the robustness of the model. The base-case analysis, over a lifetime horizon, resulted in a total cost and utilities per person for SHL FVIII, EHL FVIII, and emicizumab of $27.2 million (M), $36.7M, and $26.2M, respectively, and 31.30, 31.16, and 31.61 quality-adjusted life years, respectively. Emicizumab treatment resulted in 29 and 16 less bleeds in a lifetime compared to SHL FVIII and EHL FVIII, respectively. Probabilistic sensitivity analysis showed that emicizumab was cost-saving 100% of the time compared to SHL FVIII and EHL FVIII. The cost-utility analysis showed that emicizumab is more effective and may be less costly than FVIII for Canadian haemophilia A patients, conditional on drug cost assumptions. Our model indicates that emicizumab may be a potentially favourable treatment option for minimising healthcare costs and providing higher effectiveness.

Persepsi Konsumen dalam Melakukan Pembayaran BPJS Kesehatan dengan Menggunakan E-Wallet di Masa Pandemi Covid-19

This study aims to determine and analyze perceptions of ease of use and perceived risk of interest in using e-wallets in BPJS Health payments and trust as a moderating variable. This research method is descriptive quantitative. The population in this study is the people of Surabaya City. This study used a purposive sampling technique with a total sample of 100 people. The results showed that perceived ease of use had a significant positive effect, while perceived risk had no effect on the intention to use e-wallets for BPJS Health payments. Trust shows being able to moderate perceptions of ease of use, but trust is not able to moderate perceived risk of interest in using e-wallets in making BPJS Health payments.&#x0D; Keywords: Health BPJS, E-Wallet, Trust, Consumer Perception

Economic Evaluation of Immune Tolerance Induction in Children With Severe Hemophilia A and High-Responding Inhibitors: A Cost-Effectiveness Analysis of Prophylaxis With Emicizumab

ObjectiveThis study aimed to measure the cost-effectiveness of prophylaxis with emicizumab in PsHAhri on ITI in Brazil. MethodsA cost-effectiveness modeling analysis was used to estimate the costs per PsHAhri on ITI and the number of prevented bleedings from undertaking one intervention (prophylaxis with BpA) over another (prophylaxis with emicizumab), based on the Brazilian Ministry of Health perspective. Costs of ITI with recombinant FVIII, prophylaxis with BpA or emicizumab, and treated bleeding episodes with BpA costs were evaluated for PsHAhri who had ITI success or failure. This study was conducted with the perspective of the Brazilian Ministry of Health (payer). ResultsDuring ITI, prophylaxis with BpA cost US $924 666/PsHAhri/ITI, whereas prophylaxis with emicizumab cost US $488 785/PsHAhri/ITI. During ITI, there was an average of 9.32 bleeding episodes/PsHAhri/ITI when BpA were used as prophylaxis and 0.67 bleeding/PsHAhri/ITI when emicizumab was used. By univariate deterministic sensitivity analysis, emicizumab remained dominant whichever variable was modified. ConclusionIn this study, prophylaxis with emicizumab during ITI is a dominant option compared with prophylaxis with BpA during ITI.

Cost-Utility of Immunosuppressive Therapy Post-Renal Transplantation in Saudi Arabia: The Saudi Ministry of Health Perspective

ObjectivesChronic kidney disease is ranked fourth among the top 10 causes of death in Saudi Arabia. Renal transplantation has been recognized as the treatment of choice compared with long-term dialysis to maintain graft survival and prolong a patient’s healthy living. Immunosuppressants (ISs) must be administered lifelong. The choice between IS therapies can be challenging because of the similarity in efficacy with some differences in adverse events profile. The objective of this study was to assess the cost-effectiveness of different IS regimens in Saudi Arabia. MethodsA 25-year Markov model was developed based on a previously published study from the Saudi Ministry of Health payer perspective. Efficacy parameters were driven from the literature, whereas cost data were estimated from the Ministry of Health database. A Monte Carlo simulation was conducted to test the base-case model results’ robustness. ResultsAll comparators resulted in 6.2 quality-adjusted life-years (QALYs) except for Advagraf® treatment (5.5 QALYs). Generic tacrolimus plus mycophenolate mofetil (MMF) will cost 70 701.45 US dollars ($) (Saudi riyal 265 130.44) per patient to gain 6.2 QALYs over 25 years’ time horizon. In the improved adherence scenario, Envarsus® plus generic MMF generated 9.6 QALYs with a cost of $59 849 per patient. Monte Carlo simulation results have shown that generic tacrolimus is still the cheapest treatment option compared with other treatment arms. ConclusionsThe current analysis suggested that all IS options are not cost-effective strategies relative to the willingness-to-pay threshold of $20 000. Nevertheless, Envarsus plus generic MMF regimen could become the most cost-effective regimen at different willingness-to-pay thresholds.

Disparity in Catastrophic Healthcare Expenditures Across Households’ Income Groups in Nigeria: The Lens of Foster-Greer-Thorbecke Poverty Indices

The Nigeria health care system seems to have continue in the downturn trend as a result of the decay in public health care system and this have continued to drive the rising health care financed by out-of-pocket expenditure health hence, the study examined the disparity in Catastrophic Healthcare expenditures across Households income groups in Nigeria using the Nigeria Health and Demographic Survey 2018. The study employed the Foster-Greer-Thorbecke indices and the logit model. Findings from the study showed that some household and individual characteristics are associated with catastrophic health expenditure in Nigeria. Many households experience catastrophic health payments due to factors such as age, education of household head, health insurance status, geo- political zone, type of health facilities visited, and type of illness suffered. Governments are yet to find fair and innovative ways of financing the health system so as to reduce the financial burden of out-of-pocket payments on households and individuals in Nigeria. There is also urgent need for increased financial protection as well as insurance coverage through small credit and rural households’ contribution scheme as an alternative to the National Health Insurance Scheme to enhance health financing option that could reduce the huge private health cost of out-of-pocket expenditure. There is need for pressure on the legislature to provide a bill that disallow health care tourism for public office holders abroad as way of checkmating the better health care system in Nigeria. Keywords: Health care, Inequality, Income groups, private health cost, households DOI: 10.7176/JESD/13-20-03 Publication date: October 31 st 2022