ORCID Profile
0000-0002-7402-7519
Current Organisation
Murdoch University
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Publisher: American Medical Association (AMA)
Date: 09-2017
Publisher: Elsevier BV
Date: 09-2017
Publisher: Elsevier BV
Date: 09-2018
Publisher: Public Library of Science (PLoS)
Date: 24-06-2022
DOI: 10.1371/JOURNAL.PONE.0269113
Abstract: Ensuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh. Using Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons. OOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%). Financial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 09-2020
Publisher: Oxford University Press (OUP)
Date: 12-2015
Abstract: Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications. Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence). Households with angina (asthma) reported greater OOP spending (angina: range I$1.94-I$4.31 asthma: range I$1.53-I$2.01) (I$1 = 125.09 Myanmar Kyats I$=International Dollar) almost half of which was spending on medicines higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6-7% asthma: range 3-5%) greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12-14% asthma: range 40-49%) increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption. Myanmar is expanding public spending on health and has recently launched an innovative programme for supporting hospital-based care for poor households. Our findings suggest the need for interventions to address OOP expenses associated with outpatient care (including drugs) for chronic conditions in Myanmar's population.
Publisher: Oxford University Press (OUP)
Date: 07-09-2012
Abstract: Volunteer community health workers (CHWs) are one approach to addressing the health workforce shortage in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in using female volunteer CHWs as core workers in its successful health programmes. After 25 years of implementing the CHW model in rural areas, BRAC is now using CHWs in urban slums of Dhaka through Manoshi, a community-based maternal and child health project. However, high dropout rates among CHWs in the slums suggested a need to better understand factors associated with their retention, and consequently recommend strategies for increasing their retention. This mixed-method study included a case-control design to assess factors relating to the retention of volunteer CHWs, and focus group discussions (FGDs) to explore solutions to problems. In total, 542 current and 146 dropout CHWs participated in the survey. Six FGDs were held with groups of current and groups of dropout CHWs. Financial incentives were the main factor linked to CHW retention. CHWs who joined with the expectation of income were almost twice as likely to remain as CHWs. This finding was reinforced by the inverse association between wealth quintile of the CHWs and retention the poorest CHWs were significantly more likely to stay in the programme than the richest. However, social prestige, community approval and household responsibilities were important non-financial factors associated with CHW retention. Restructuring and expansion of existing financial incentives to better compensate CHWs were recommended by CHWs to improve their retention. Factors found to be important in this study are similar to those from earlier studies in rural areas. While the data indicate that financial incentives are the most commonly discussed factor regarding CHW retention in urban slums, the results also suggest other avenues that could be strengthened to improve their retention.
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 22-06-2023
DOI: 10.1186/S12884-023-05778-0
Abstract: Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan. The study used the latest Demographic and Health Survey (DHS, 2017–2018) datasets of Bangladesh and Pakistan for women aged 15–49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated. In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women’s education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624 and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643 and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595 and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women’s education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743). Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Elsevier BV
Date: 05-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Elsevier BV
Date: 06-2022
Publisher: American Diabetes Association
Date: 16-10-2016
DOI: 10.2337/DC16-1075
Abstract: The prevalence of diabetes in the Eastern Mediterranean Region (EMR) is among the highest in the world. We used findings from the Global Burden of Disease 2013 study to calculate the burden of diabetes in the EMR. The burden of diabetes and burden attributable to high fasting plasma glucose (HFPG) were calculated for each of the 22 countries in the EMR between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, deaths, and disability-adjusted life years (DALYs). The diabetes death rate increased by 60.7%, from 12.1 per 100,000 population (95% uncertainty interval [UI]: 11.2–13.2) in 1990 to 19.5 per 100,000 population (95% UI: 17.4–21.5) in 2013. The diabetes DALY rate increased from 589.9 per 100,000 (95% UI: 498.0–698.0) in 1990 to 883.5 per 100,000 population (95% UI: 732.2–1,051.5) in 2013. In 2013, HFPG accounted for 4.9% (95% UI: 4.4–5.3) of DALYs from all causes. Total DALYs from diabetes increased by 148.6% during 1990–2013 population growth accounted for a 62.9% increase, and aging and increase in age-specific DALY rates accounted for 31.8% and 53.9%, respectively. Our findings show that diabetes causes a major burden in the EMR, which is increasing. Aging and population growth do not fully explain this increase in the diabetes burden. Programs and policies are urgently needed to reduce risk factors for diabetes, increase awareness of the disease, and improve diagnosis and control of diabetes to reduce its burden.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Springer Science and Business Media LLC
Date: 30-09-2022
DOI: 10.1186/S12889-022-14243-0
Abstract: Demographic and epidemiological transitions are changing the disease burden from infectious to noncommunicable diseases (NCDs) in low- and middle-income countries, including Bangladesh. Given the rising NCD-related health burdens and growing share of household out-of-pocket (OOP) spending in total health expenditure in Bangladesh, we compared the country’s trends and socioeconomic disparities in financial risk protection (FRP) among households with and without NCDs. We used data from three recent waves of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016) and employed the normative food, housing (rent), and utilities method to measure the levels and distributions of catastrophic health expenditure (CHE) and impoverishing effects of OOP health expenditure among households without NCDs (i.e. non-NCDs only) and with NCDs (i.e. NCDs only, and both NCDs and non-NCDs). Additionally, we examined the incidence of forgone care for financial reasons at the household and in idual levels. Between 2005 and 2016, OOP expenses increased by more than 50% across all households (NCD-only: USD 95.6 to 149.3 NCD-and-non-NCD: USD 89.5 to 167.7 non-NCD-only: USD 45.3 to 73.0), with NCD-affected families consistently spending over double that of non-affected households. Concurrently, CHE incidence grew among NCD-only families (13.5% to 14.4%) while declining (with fluctuations) among non-NCD-only (14.4% to 11.6%) and NCD-and-non-NCD households (12.9% to 12.2%). Additionally, OOP-induced impoverishment increased among NCD-only and non-NCD-only households from 1.4 to 2.0% and 1.1 to 1.5%, respectively, affecting the former more. Also, despite falling over time, NCD-affected in iduals more frequently mentioned prohibiting treatment costs as the reason for forgoing care than the non-affected (37.9% vs. 13.0% in 2016). The lowest quintile households, particularly those with NCDs, consistently experienced many-fold higher CHE and impoverishment than the highest quintile. Notably, CHE and impoverishment effects were more pronounced among NCD-affected families if NCD-afflicted household members were female rather than male, older people, or children instead of working-age adults. The lack of FRP is more pronounced among households with NCDs than those without NCDs. Concerted efforts are required to ensure FRP for all families, particularly those with NCDs.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 15-07-2019
DOI: 10.1038/S41598-019-46766-9
Abstract: Aims : The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.
Publisher: Springer Science and Business Media LLC
Date: 20-05-2014
Publisher: Springer Science and Business Media LLC
Date: 03-08-2018
Publisher: Springer Science and Business Media LLC
Date: 03-08-2018
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 13-03-2023
DOI: 10.1186/S12978-023-01595-Y
Abstract: Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan. The study used the latest Demographic Health Surveys (DHS, 2017–2018) datasets of Bangladesh and Pakistan for women aged 15–49 years who had given at least one live birth in three years preceding the survey. Equity strata were identified from the literature and conformed by binary logistic regressions. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI) and the slope index of inequality (SII) were calculated to measure inequalities in the utilization of four maternal healthcare services. For two-categories equity strata, rate ratio (RR), and rate difference (RD) were calculated. Concentration curves and equiplots were constructed to visually demonstrate inequality in maternal healthcare services. In Bangladesh, there was greater inequality in skilled birth attendance (SBA) based on wealth (RCI: 0.424, ACI: 0.423, and SII: 0.612), women’s education (RCI: 0.380, ACI: 0.379 and SII: 0.591), husband’s education (RCI: 0.375, ACI: 0.373 and SII: 0.554) and birth order (RCI: − 0.242, ACI: − 0.241, and SII: -0.393). According to RCI, ACI, and SII, there was inequality in Pakistan for at least four ANC visits by the skilled provider based on wealth (RCI: 0.516, ACI: 0.516 and SII: 0.738), women’s education (RCI: 0.470, ACI: 0.470 and SII: 0.757), and husband’s education (RCI: 0.380, ACI: 0.379 and SII: 0.572). For Bangladesh, the RR (1.422) and RD (0.201) imply more significant urban–rural inequality in SBA. In Pakistan, urban–rural inequality was greater for at least four ANC visits by the skilled provider (RR: 1.650 and RD 0.279). Inequality in maternal healthcare is greater among the underprivileged group in Pakistan than in Bangladesh. In Bangladesh, the SBA is the most inequitable maternal healthcare, while for Pakistan it is at least four ANC visits by the skilled provider. Customized policies based on country context would be more effective in bridging the gap between the privileged and underprivileged groups.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Elsevier BV
Date: 06-2019
Publisher: SAGE Publications
Date: 25-11-2014
Abstract: The government of Myanmar, with support from international donors, plans to address household financial risks from ill health and expand coverage. But evidence to design policy is limited. WHS (World Health Survey) data for 6045 households were used to investigate the association of out-of-pocket (OOP) health spending, catastrophic expenditures, and household borrowing and asset sales associated with illness with key socioeconomic and demographic correlates in Myanmar. Households with elderly and young children and chronically ill in iduals, poor households, and ethnic minorities face higher financial stress from illness. Rural households use less care, suggesting their lower OOP health spending may be at the cost of health. Poorer groups rely more on public sector health services than richer groups. Better targeting, increased budgetary allocations, and more effective use of resources via designing cost-effective benefits packages appear key to sustainably addressing financial risks from ill health in Myanmar.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 2014
Publisher: Elsevier BV
Date: 05-2017
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.SOCSCIMED.2012.03.039
Abstract: Volunteer community health workers (CHWs) are one approach to addressing the health workforce crisis in developing countries. BRAC, a large Bangladeshi NGO, a pioneer in this area, uses female volunteer CHWs as core workers in its health programs. After 25 years of implementing the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through its community-based mother, newborn and child health interventions. However, the program experienced suboptimal performance among CHWs, with a high percentage of them remaining in their positions but becoming "inactive", not truly participating in daily community health activities. This suggests a need to better understand the relative importance of factors affecting their active participation and to recommend strategies for improving their participation. This mixed-method study included a descriptive correlational design to assess factors relating to level of activity of CHWs and focus group discussions to explore solutions to these problems. A s le of 542 current female CHWs from project areas participated in the survey. Financial incentives were the main factor linked to the activity of CHWs. CHWs who thought that running their families would be difficult without CHW income had more than three times greater odds to become active. In addition, social prestige and positive community feedback to the CHWs were important non-financial factors associated with level of activity. In order to improve volunteer CHWs' performance, a combination of financial and non-financial incentives should be used.
Publisher: Springer Science and Business Media LLC
Date: 16-10-2023
Publisher: Elsevier BV
Date: 10-2012
Publisher: Springer Science and Business Media LLC
Date: 24-06-2023
DOI: 10.1038/S41598-023-37519-W
Abstract: Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018–2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1 confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2 CI:1.9, 19.9].
Publisher: American Medical Association (AMA)
Date: 28-08-2018
Publisher: International Global Health Society
Date: 29-07-2018
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: American Society of Tropical Medicine and Hygiene
Date: 07-12-2016
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 21-05-2017
DOI: 10.1111/ALL.13162
Abstract: Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for in iduals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.
Publisher: Elsevier BV
Date: 2017
Publisher: BMJ
Date: 16-02-2017
DOI: 10.1136/ANNRHEUMDIS-2016-210146
Abstract: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3–1703.4) in 1990 to 1606.0 (95% UI 1141.2–2130.4) in 2013. During 1990–2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7–3.0) in 1990 to 4.7% (95% UI 3.6–5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2–136.0 for low back pain, 27.3–49.7 for neck pain, 9.7–37.3 for osteoarthritis (OA), 0.6–2.2 for rheumatoid arthritis and 0.1–0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2014
Publisher: Elsevier BV
Date: 05-2018
Publisher: Elsevier BV
Date: 2019
Publisher: Elsevier BV
Date: 03-2023
Publisher: Springer Science and Business Media LLC
Date: 19-02-2014
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1038/GIM.2016.221
Abstract: To undertake the first prospective cost-effectiveness study of whole-exome sequencing (WES) as an early, routine clinical test for infants with suspected monogenic disorders. Cost data for diagnosis-related investigations and assessments were collected for a prospective, sequential clinical cohort of infants (N = 40) who underwent singleton WES in parallel to usual diagnostic care. We determined costs per patient, costs per diagnosis, and incremental costs per additional diagnosis for three alternative strategies for integrating WES into the diagnostic trajectory. We performed a sensitivity analysis to examine the robustness of estimates and bootstrapping (500 replications) to examine their distributions. Standard care achieved an average cost per diagnosis of AU$27,050 (US$21,099) compared with AU$5,047 (US$3,937) for singleton WES. If WES had been performed after exhaustive standard investigation, then there would have been an incremental cost per additional diagnosis of AU$8,112 (US$ 6,327). Using WES to replace some investigations decreases this incremental cost to AU$2,622 (US$2,045), whereas using it to replace most investigations results in a savings per additional diagnosis of AU$2,182 (US$1,702). Use of WES early in the diagnostic pathway more than triples the diagnostic rate for one-third the cost per diagnosis, providing strong support for reimbursement as a clinical test.Genet Med advance online publication 26 January 2017.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Springer Science and Business Media LLC
Date: 27-08-2019
Publisher: Springer Science and Business Media LLC
Date: 29-07-2022
DOI: 10.1186/S12961-022-00886-3
Abstract: Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2017
DOI: 10.1038/S41525-017-0006-7
Abstract: Childhood-onset muscle disorders are genetically heterogeneous. Diagnostic workup has traditionally included muscle biopsy, protein-based studies of muscle specimens, and candidate gene sequencing. High throughput or massively parallel sequencing is transforming the approach to diagnosis of rare diseases however, evidence for cost-effectiveness is lacking. Patients presenting with suspected congenital muscular dystrophy or nemaline myopathy were ascertained over a 15-year period. Patients were investigated using traditional diagnostic approaches. Undiagnosed patients were investigated using either massively parallel sequencing of a panel of neuromuscular disease genes panel, or whole exome sequencing. Cost data were collected for all diagnostic investigations. The diagnostic yield and cost effectiveness of a molecular approach to diagnosis, prior to muscle biopsy, were compared with the traditional approach. Fifty-six patients were analysed. Compared with the traditional invasive muscle biopsy approach, both the neuromuscular disease panel and whole exome sequencing had significantly increased diagnostic yields (from 46 to 75% for the neuromuscular disease panel, and 79% for whole exome sequencing), and reduced the cost per diagnosis from USD$16,495 (95% CI: $12,413–$22,994) to USD$3706 (95% CI: $3086–$4453) for the neuromuscular disease panel and USD$5646 (95% CI: $4501–$7078) for whole exome sequencing. The neuromuscular disease panel was the most cost-effective, saving USD$17,075 (95% CI: $10,654–$30,064) per additional diagnosis, over the traditional diagnostic pathway. Whole exome sequencing saved USD$10,024 (95% CI: $5795–$17,135) per additional diagnosis. This study demonstrates the cost-effectiveness of investigation using massively parallel sequencing technologies in paediatric muscle disease. The findings emphasise the value of implementing these technologies in clinical practice, with particular application for diagnosis of Mendelian diseases, and provide evidence crucial for government subsidy and equitable access.
Publisher: Elsevier BV
Date: 02-2019
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Elsevier BV
Date: 10-2021
Publisher: Springer Science and Business Media LLC
Date: 17-08-2023
DOI: 10.1186/S12889-023-16498-7
Abstract: The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. This study analysed cross-sectional data from the most recent round (2018–19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by in iduals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2018
Publisher: Public Library of Science (PLoS)
Date: 21-10-2016
Publisher: American Medical Association (AMA)
Date: 05-2018
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JACI.2016.03.025
Abstract: The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. Clinical decision support systems (CDSSs) might be beneficial for the assessment of disease control. CDSSs should be based on the best evidence and algorithms to aid patients and health care professionals to jointly determine treatment and its step-up or step-down strategy depending on AR control. Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR [fighting chronic diseases for active and healthy ageing]), one of the reference sites of the European Innovation Partnership on Active and Healthy Ageing, has initiated an allergy sentinel network (the MACVIA-ARIA Sentinel Network). A CDSS is currently being developed to optimize AR control. An algorithm developed by consensus is presented in this article. This algorithm should be confirmed by appropriate trials.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: Elsevier BV
Date: 05-2017
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.DSX.2019.03.001
Abstract: The aim was to estimate the burden of macro- and micro-vascular complications on hospitalisation and healthcare cost among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out in 2017. A total of 1253 patients were recruited from six hospitals. Information related to cost and complications of type 2 diabetes were collected. Multiple logistic and non-parametric regression analyses were performed to evaluate the effect of complications on hospitalisation and average annual cost. Overall, 63.4% of the participants had complications of which 14.8% and 20.7% had macro- and micro-vascular complications respectively and 27.9% had both. Use of insulin, presence of both hypertension and dyslipidaemia, coronary artery diseases, stroke, nephropathy, and retinopathy were significantly associated with hospitalisation. Further, use of oral hypoglycaemic agent with a combination of insulin, presence of coronary artery diseases, stroke, nephropathy, and retinopathy increased the average annual cost. The prevalence of macro- and micro-vascular complications were very high in Bangladesh and majority of them are key drivers for hospitalisation and increased healthcare cost. An improvement of primary prevention strategy for complications is urgently needed which in turn will reduce the long-term healthcare cost for type 2 diabetes in Bangladesh.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2023
DOI: 10.1007/S00127-022-02310-1
Abstract: Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia’s mixed public–private health care system is lacking. To present a novel method to measure inequity in the delivery of psychiatric care. Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity. The results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all in iduals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively. This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Bangladesh Journals Online (JOL)
Date: 30-05-2019
Abstract: Background: Diabetes is one of the most prevalent non-communicable diseases (NCDs) all over the world and leading cause of death, disability, and economic loss. Diabetes imposes a heavy economic burden on in iduals, their families and society as a whole. The aim of this study is to estimate the economic burden of type 2 diabetes mellitus (T2DM) in Bangladesh and to find association between glycemic control and Health Related Quality of Life with cost-of-illness (COI). Methodology: This will be an analytical cross-sectional cost-of-illness study. Within a specific time period participants aged ≥18 years, registered with Bangladesh Diabetic Somiti and having type 2 diabetes for more than one year will be recruited from selected hospitals inside and outside Dhaka to cover all level of health care services. A pre-tested electronic questionnaire will be used for data collection. The questionnaire will include demographic, clinical, behavioral information of the participants and all cost related information related to diabetes management during last one year. Descriptive statistics will include mean (±SD) or median (percentile) or relative frequencies (percentage) depending on the data. Two s les independent t-test or Mann-Whitney U-test, ANOVA or Kruskal-Wallis test and chi-squared tests will be used for univariate analysis. The multivariable regression analysis and bootstrap method will also be employed to analyze the relationship between the total cost of care (dependent variable) and several potential explanatory variables (independent variables). Logistic regression analysis will be performed to assess the factors affecting glycemic control and health related quality of life (HRQoL). The calculated total cost-of-illness will be projected for T2DM in Bangladesh by a mathematical modelling. Result & discussion: The results of the study will be useful as background information to forecast the economic burden of type 2 diabetes mellitus in Bangladesh and will be beneficial to conceptualize health strategies at national level. Furthermore, recognizing the factors of cost-of-illness will help both patients and health care providers to improve the management plan and cost control and hence, to have better quality of life. Evidence about the magnitude of the burden of T2DM is important for public health policymakers who are involved in making health care priorities and allocating scarce resources to facilitate the greatest benefits for type 2 diabetic people in Bangladesh. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.501-507
Publisher: Elsevier BV
Date: 07-2017
Start Date: 2021
End Date: End date not available
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2022
End Date: End date not available
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2020
Funder: National Health and Medical Research Council
View Funded Activity