Pih30 Challenges Faced by People With Physical Disabilities in Accessing Sexual and Reproductive Health Services in Eastern Region of Nepal

Abstract

Inborn error of metabolism (IEM) was very rare hereditary disease. Newborn screening by Tandem mass spectrometry (MS/MS) program which can detect 17 diseases of inborn error of metabolism has been introduced in Japan since 2011. The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of the MS/MS tests compared with Guthrie (GC) tests. Methods: A costutility analysis was conducted. We constructed a decision-tree and Markov model to compare life-time costs and quality-adjusted life-years (QALY). The comparisons were made between a current newborn screening program using MS/MS tests and a past screening program using GC tests. We conducted a systematic review to collect health benefits values. Treatment costs and disease progression rates were estimated using an administrative database in Japan. Disease prevalence and mortality rate were obtained from publications from government and Bulletin of the Japan Cooperative Project on Special Formula. Results: The ICER of MS/MS tests compared with GC tests was 2 million JPY per QALY (approximately $19,000 per QALY) which was lower than the willingness-to-pay threshold of 5 million JPY in Japan. Conclusions: Introduction of the new program with MS/MS tests has incurred additional costs to insurance payer; however, it has also yielded additional QALYs. Therefore, from the perspective of Japanese healthcare system, the MS/MS tests seemed to be cost-effective. However, the data of IEM such as incidence, transition probabilities, and utility, were limited, a long-term epidemiological study for the IEM patients is needed to reduce uncertainty of this analysis.

Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research

“…The results on higher affordability and willingness to pay for FP services among women in urban areas, those with higher education and those in higher socio-economic status are similar to findings in a study in Nigeria 31 . Findings on higher willingness to pay (WTP) for FP among middle aged people, those without a disability are consistent with those found in several studies in Asia and Africa 11 , 32 , 33 .…”

Barriers and facilitators to sexual and reproductive health rights for Persons with Disability in Nepal: a scoping review

“…Participants felt humiliated when asking another person to change their menstrual product, and guilt seeing their care providers handle their menstrual blood 29 . Education Knowledge and information Three 28,29,32 Nearly 26.7% of PWDs do not have knowledge about the disability rights provided by the government and 94.2% of the respondents think there is no easy access of SRH services for them 28 . Socioeconomic status Three 31,32,34 Those women with disabilities who were ever married are 122 times more likely to utilize SRH services compared to those who were never married 32 .…”

“…Six [28][29][30][31]38,39 Inconvenient and limited opening hours of health facilities were often reported by participants in their qualitative interviews as one of the reasons for non-utilization of services 31 . Knowledge Three 30,33,34 .…”

“…Another study reported campaign ensuring to help people with intellectual impairment and their carers in regards to menstrual hygiene management 36 . Individual Out of the eleven publication reporting on individual level barriers (27)(28)(29)(30)(31)(32)(33)(34)(35) , (36,40), four publications (28,29,32) , (36) identified lack of information and knowledge about the disability and SRH service availability as a barrier. For example, a study exploring barriers to menstrual hygiene among adolescent girls with disabilities reported that the guardian were in disbelief when they had menses as they presumed menarche would be delayed or not have menses (29).…”

“…For example, a study exploring barriers to menstrual hygiene among adolescent girls with disabilities reported that the guardian were in disbelief when they had menses as they presumed menarche would be delayed or not have menses (29). A quantitative study exploring challenges of seeking SRH services by PWDs reported that nearly 94.2% thought the SRH services were inaccessible (28), and another article reported that women with disabilities do not report violence because they lack information on where and how to report (33). Four articles identified perceived low self-efficacy and esteem from experiencing constant fear and humiliation as a barrier for women with disabilities to exercise SRH rights (27,29,31,34).…”