| The economic cost to households of childhood malaria in Papua New Guinea: a focus on intra-country variation. | |
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MedLine Citation:
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PMID: 21697246 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND We compare direct and indirect household costs associated with malaria treatment for children <3 years in two provinces of Papua New Guinea. In particular, we explore the role of uncertainty around mean household costs and whether assuming a normal distribution for household costs limits the accuracy of any direct cost comparisons. METHODS Exit surveys were undertaken at inpatient and outpatient health facilities. In order to handle uncertainty and facilitate comparisons, parametric and non-parametric bootstrap methods were used to estimate direct and indirect costs at the individual data level. The inpatient and outpatient incremental costs from Madang and Maprik health facilities were compared and significant differences between provinces were identified. RESULTS Differences were noted between provinces for both inpatient and outpatient household costs. Total arithmetic mean costs for an outpatient malaria episode were US$7.54 in Madang and US$9.20 in Maprik. Total mean inpatient malaria episode costs were US$25.20 in Madang and US$14.08 in Maprik. As cost distributions were not normal, non-parametric bootstrap techniques were used for cost comparisons. Total household costs per outpatient episode of malaria were lower, although not significantly, in Maprik than in Madang (incremental cost of US$ -1.67; 95% CI -4.16, 0.31), while total household costs per inpatient episode were significantly higher in Madang than in Maprik (difference of US$11.16; 95% CI 5.47, 25.33). A difference was noted between provinces in the proportion of indirect costs in total household costs for an outpatient visit: 76% in Madang vs 94% in Maprik. The proportion for indirect costs associated with inpatient visits varied less: 63% in Madang vs 68% in Maprik. CONCLUSIONS Intra-country differences need to be considered in estimating household costs for both outpatient and inpatient malaria treatment. Our findings suggest that it is important to recognize the impact of both direct and indirect costs on individuals' capacity to afford treatment. Certain indirect costs are difficult to measure accurately, particularly respondents' interpretations of their productive versus non-productive time. Despite this, exploring intra-country cost variation can provide important information to health policy makers. |
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Authors:
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Elisa Sicuri; Carol Davy; Marcella Marinelli; Olive Oa; Maria Ome; Peter Siba; Lesong Conteh; Ivo Mueller |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-6-22 |
Journal Detail:
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Title: Health policy and planning Volume: - ISSN: 1460-2237 ISO Abbreviation: - Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-6-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8610614 Medline TA: Health Policy Plan Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province, Papua New Guinea, University of Adelaide, South Australia, Centre of Research of Environmental Epidemiology (CREAL), Barcelona, Spain, IMIM (Hospital del Mar Research Institute), Swiss Tropical and Public Health Institute, Basel, Switzerland and Institute of Global Health Innovation, Imperial College London. |
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