Direct Medical Cost of Treatment of uncomplicated malaria after the Adoption of artemisinin-Based Combination Therapy in Nigeria

Abstract

Globally, malaria continues to have clinical importance and economic impact. There is insufficient data on direct medical costs of malaria treatment at healthcare facilities since the adoption of artemisinin combination therapies (ACTs) in Nigeria. The study aimed to assess the direct medical cost incurred by patients with uncomplicated malaria disease after the adoption of ACTs. The study was retrospective. Data were collected from malaria patients' folders between January 2014 and June 2018 in two secondary hospitals. Costing was carried out using the National Health Insurance Scheme price list (second edition). Descriptive statistics, measures of central tendency, and dispersion were used. A total of 2,420 patient folders were assessed. The prevalence of uncomplicated malaria increased every year, with 2017 having the highest number (n = 754). The average direct medical cost incurred per patient for the treatment of uncomplicated malaria treatment was 2,234.07 ± 1,307 NGN (US $5.8) which accounts for 12.4% of the national minimum wage earnings. About a third (64.6%) of the patients were treated with artemether-lumefantrine tablets. The mean cost of antimalarial drugs per treatment episode was 748.87 ± 336.75 NGN (US $1.96). The direct cost of malaria treatment was high contributing to the significant economic burden even after the adoption of ACTs in Nigeria.

Private sector availability and affordability of under 5 malaria health commodities in selected states in Nigeria and the Federal Capital Territory

“…The median prices of surveyed products are higher than in earlier years and may potentially be linked to the end of the AMFm and PSCM projects, where quality-assured malaria medicines were subsidised (Ebere Emilia et al, 2021 ; Ezenduka et al, 2013 ; Ezenduka et al, 2014 ), or COVID-19 pandemic, which has been suggested to be responsible for more than a 50% rise in the price of essential medicines in Nigeria (Emmanuel Awucha et al, 2020 ). A study after the subsidy project suggests the continued impact of the project on prices of ACTs (Akulayi et al, 2017 ) thus COVID 19 pandemic may be a major contributing factor to the higher prices observed in this study.…”

A Comparison of Healthcare Funding Systems between Low- /Medium-Income and High-Income Countries: Equity, Equality, and Fairness in the Rationing of Healthcare Resources

“…Huge out-of-pocket expenditures are made on health and education, as well as an array of other non-food items such as transport, fuel, electricity, household items, and clothing (The World Bank, 2022a, p. 11-14) The current World Health Organisation (WHO) national health account data on financing schemes as a percentage of current health expenditure (CHE) for the year 2020 estimates that in Nigeria, OOPS accounts for approximately 75%, while government schemes and compulsory contributory (social) health insurance schemes account for about 15% and 1%, respectively (WHO, 2023;The World Bank, 2023). This structure of healthcare financing which relies heavily on OOPS has not only proven to be unprogressive, and financially unprotective of the poor but also promotes inequality and catastrophic health spending, as well as impoverishment of the vulnerable group and the poor who live below US$2 a day (Adekunle, 2022; Ayogu et al, 2021;Olakunde, 2012;Oyibo, 2011). Fortunately, the recently signed National Health Insurance Authority Act (2022) gives a ray of hope to the poor and vulnerable.…”

“…It is responsible for catastrophic personal healthcare spending, and loss of income as a result of absence from work. A large portion of the OOPS segment of the total health expenditure of Nigeria is due to malaria (Ayogu et al, 2021). Thus, reducing the malaria epidemic in the country will contribute greatly to the principles of UHC and the attainment of the already outlined SDGs (Adelakun, 2022).…”

“…Effectiveness (benefits) have been assessed based on, (i) field activities or nonclinical outcomes such as doses administered, rounds of treatments (or doses) per year or season, nets distributed, cases tested, cases diagnosed (presumptively, rapid diagnostic test (RDT), microscopy), cases treated (complicated, severe, uncomplicated), degree of coverage, and retention in care or follow-up; (ii) clinical outcomes such as a reduction in transmission rate, parasitemia, new infections, and adverse events and serious adverse events (AE/SAE); and (iii) utility outcomes such as quality-adjusted life years (QALYs) gained, life years (LY) saved, healthy life years (HLYs), DALYs averted, number of persons protected, infant deaths averted, Children under-5 protected, clinical cases or episode averted, etc. (Avanceña et al, 2022;Ayogu et al,2021;Conteh et al, 2021;Gunda, and Chimbari, 2017). Ezenduka et al (2017) estimate that treatment of uncomplicated malaria consumes about 25% of the annual budget of public health facilities in Nigeria at the cost of over US$31 per case, with personnel cost accounting for approximately 83% of the costs.…”

“…An earlier study by Onwujekwe et al (2013, as cited in Ezenduka et al, 2017 estimates between US$30.42 and US$48.02 as recurrent provider cost per case of malaria treatment for each outpatient and inpatient care, respectively, while US$133.07 and US$1857.15 were the non-recurrent provider costs per case, respectively. An analysis of the direct cost for treatment of uncomplicated malaria by Ayogu et al (2021), indicates that the mean cost of antimalarial drugs (using artemisinin-based combination therapies [ACTs]) per treatment episode was $1.96, which is higher than the specified poverty line of US$1.93. The cost outlay from reported studies suggests that the cost of treatment of a single episode is above the Nigerian poverty line, thus, making treatment unaffordable for poor and vulnerable groups i.e., children, adolescent girls, women, the elderly, malnourished people, and those who are ill or with pre-existing health conditions or disabilities, as defined in the National Health Act (2014).…”