Measurement and valuation of health providers’ time for the management of childhood pneumonia in rural Malawi: an empirical study

Abstract

BackgroundHuman resources are a major cost driver in childhood pneumonia case management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in Malawi can lead to savings on staff time and salaries due to reductions in pneumonia cases requiring admission. Reliable estimates of human resource costs are vital for use in economic evaluations of PCV-13 introduction.MethodsTwenty-eight severe and twenty-four very severe pneumonia inpatients under the age of five were tracked from admission to discharge by paediatric ward staff using self-administered timesheets at Mchinji District Hospital between June and August 2012. All activities performed and the time spent on each activity were recorded. A monetary value was assigned to the time by allocating a corresponding percentage of the health workers’ salary. All costs are reported in 2012 US$.ResultsA total of 1,017 entries, grouped according to 22 different activity labels, were recorded during the observation period. On average, 99 min (standard deviation, SD = 46) were spent on each admission: 93 (SD = 38) for severe and 106 (SD = 55) for very severe cases. Approximately 40 % of activities involved monitoring and stabilization, including administering non-drug therapies such as oxygen. A further 35 % of the time was spent on injecting antibiotics. Nurses provided 60 % of the total time spent on pneumonia admissions, clinicians 25 % and support staff 15 %. Human resource costs were approximately US$ 2 per bed-day and, on average, US$ 29.5 per severe pneumonia admission and US$ 37.7 per very severe admission.ConclusionsSelf-reporting was successfully used in this context to generate reliable estimates of human resource time and costs of childhood pneumonia treatment. Assuming vaccine efficacy of 41 % and 90 % coverage, PCV-13 introduction in Malawi can save over US$ 2 million per year in staff costs alone.

Systematic review of economic evaluations for paediatric pulmonary diseases

“…For HICs, most were from a United States of America (USA) context [ 20 , 34 , 35 , 37 , 38 ]. Amongst all articles, six were CEAs [ 17 , 30 , 35 , 37 – 39 ], six were CUAs [ 18 , 21 , 27 , 32 , 33 , 36 ], two were CMAs [ 25 , 40 ], and eight were cost analyses [ 22 – 24 , 26 , 28 , 29 , 31 , 34 ] (see Table 2 ). Of the EEs included 17/22 were trial-based, and 5/22 [ 17 , 22 , 30 , 32 , 39 ] were model-based.…”

“…2 ), we identified 8 articles on asthma [ 29 , 33 – 39 ], eleven on pneumonia [ 18 , 20 – 22 , 24 , 26 – 28 , 31 , 32 , 40 ], two on both asthma and pneumonia [ 23 , 25 ] and one on tuberculosis (TB) [ 17 ]. Articles which covered asthma were predominantly from HICs (7/8) [ 33 – 39 ], pneumonia articles were fairly evenly distributed between HICs [ 20 , 25 , 31 , 40 ] and LMICs [ 18 , 21 , 22 , 24 , 26 – 28 , 32 ], and the only TB study [ 17 ] was from a LMIC. The interventions evaluated included diagnostic tests, operational guidelines, antibiotic use (oral vs intravenous), inhaled corticosteroids and supplementary oxygen.…”

“…It shows the author details, reference year, type of economic evaluation, costing data, sensitivity analysis, informed consent, outcome measures, study duration, discount rate, hospitalisation costs (in USD) and ICERs (in USD). 77% (17/22) [ 18 , 23 , 24 , 26 , 28 – 30 , 32 – 40 ] of the articles reported hospitalisation costs, and 71% (10/14) of the full EEs reported ICERs [ 17 , 18 , 22 , 27 , 32 , 33 , 36 , 39 ]. The highest hospitalisation cost reported was USD7 245, the lowest hospitalisation cost was USD6 and the median hospitalisation cost was USD285.…”

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

“…We will conduct a prospective costing of the interventions, which will include financial (capital set-up and recurrent expenditures) and economic costs (time-motion studies),38–40 based on the provider (Ministry of Health) perspective. We will also consider the household perspective, via surveys of financial and time (opportunity) costs to caregivers.…”

Time to Recovery from Severe Pneumonia and Its Predictors Among Children 2–59 Months of Age Admitted to Pediatric Ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: Retrospective Cohort Study

“…17 According to Bozzani et al, a hospital's senior clinical staff spent 38% of their average time prescribing and providing treatment regimens for children admitted with severe pneumonia, and 26% on ward rounds. 18 For an average episode, a hospital stay includes a 5.5% chance of an adverse drug reaction, a 17.6% chance of infection, and a 3.1% chance of ulcer. Each additional night in the hospital raises the chance of bad drug reactions by 0.5%, infections by 1.6%, and ulcers by 0.5.…”