In low- and middle-income countries, the main barrier to haemophilia prophylaxis is the price of clotting factor concentrate rather than clinical knowledge. Morocco issued its first National Haemophilia Management Guide in 2023, but no local cost estimate exists to inform how far prophylaxis can be extended. We estimated the direct treatment cost of prophylaxis and on-demand treatment for a paediatric patient at a single national referral centre, using Moroccan tariffs. We used a bottom-up basket-of-care model for a reference patient (severe haemophilia A, no inhibitors, no established arthropathy; base-case weight 15 kg, 3–4 years). Nine direct medical categories were priced from the 2023 Guide and national tariff schedules (NABM; NGAP), with factor concentrate priced from Ibn Sina Hospital pharmacy procurement records reflecting actual public-sector acquisition prices (FVIII US0.50/IU, FIX US0.70/IU; 1 USD = 10 MAD, 2024). The primary perspective was the healthcare system; a limited societal extension added parental productivity loss. A one-way (univariate) deterministic sensitivity analysis varied one input at a time. Scenario analyses covered heavier weights (30 kg, 50 kg) and haemophilia B. For the 15-kg patient, annual direct medical cost was US20,136 (prophylaxis) versus US10,092 (on-demand). Factor concentrate represented 89
Evidence on inpatient-related costs for tuberculosis (TB) patients remains limited for Southwest China. This study used quantile regression to explore factors associated with inpatient expenditures among TB patients treated at a designated infectious-disease hospital in Guizhou Province, Southwest China. Baseline characteristics and inpatient cost data of TB patients admitted to a designated infectious disease hospital in Guizhou Province from January 2018 to December 2024 were retrospectively collected. Quantile regression models were applied to identify determinants of inpatient costs across different cost distributions. The findings showed that, at lower cost quantiles, self pay patients had lower inpatient costs (10th percentile; coefficient = −141.79). Conversely, patients covered by social basic medical insurance had significantly lower inpatient costs at higher cost quantiles (90th percentile; coefficient = −97 404.08). Manual labor workers and retirees had higher inpatient costs across the 10th to 90th percentiles compared with other occupational groups. Inpatient length of stay, receipt of interventional procedures, drug resistance, admission status, and comorbidities were positively associated with inpatient costs across the 10th to 90th percentiles (all P < 0.001). Cost differences existed across quantiles for different TB types: disseminated TB produced the highest costs at the 10th percentile (coefficient = 1367.35), while tuberculous meningitis incurred the highest costs from the 50th to the 90th percentiles. According to the relative importance ranking, the most influential factors (in descending order) were length of stay, admission status, TB type, procedural intervention, and occupational factors. Based on seven year consecutive inpatient data, this study indicates that TB inpatient expenditures are affected by multiple factors and differ across cost quantiles. Targeted cost containment strategies should be developed according to patient characteristics to reduce medical expenses and shorten hospital stays without impairing treatment outcomes. These findings provide theoretical evidence for formulating TB cost control policies for similar hospital settings. Caution should be exercised when generalizing these results to all TB patients across Southwest China given the single center study design.
Healthcare-associated infections (HAIs) are a major patient safety issue and a significant source of healthcare expenditure. Their economic burden is often estimated using routinely collected administrative data. Because infected and non-infected patients differ in complexity, simple comparisons may overestimate costs attributable to infection. Propensity score methods are widely used to improve comparability in observational data, yet different approaches may yield different estimates, particularly for economic outcomes. This study assessed whether different propensity score methods and estimands yield different estimates of the hospitalization costs attributable to HAIs using real-world administrative data. We analysed 12,033 hospitalizations (1,212 HAI cases) at a Rome university hospital in 2018. Costs were estimated using Diagnosis-Related Group (DRG) reimbursements. Propensity scores were calculated using logistic regression and generalized boosted models. Matching, inverse probability of treatment weighting (IPTW), and stratification were compared, with and without length of stay (LOS) in the propensity score model. Costs were analysed on the log scale and expressed as percentage increases attributable to infection. HAIs were associated with higher DRG- reimbursements, but estimates varied by analytical approach, covariate specification, and estimand. With LOS, estimates ranged from 2.85
Severe anaemia and malaria are among the leading causes of childhood hospital admissions in Africa south of the Sahara. For children being discharged from hospital, readmissions often occur raising the costs for inpatient care. This study aims to estimate healthcare provider costs for children under-five diagnosed with severe anaemia and severe malaria at Zomba and Kamuzu Central Hospitals in Malawi, Kisumu Referral Hospital in Kenya and Jinja Children’s Referral Hospital in Uganda. This is a sub-study of the clinical trial “Dihydroartemisinin-piperaquine and azithromycin for the post-discharge management of children with severe anaemia in Malawi, Kenya and Uganda”. Cost data were collected from January 2024 to October 2024. Using bottom-up costing, we estimated annual economic costs for personnel, supplies and overheads required for a paediatric medical admission, referral, and blood transfusion processes. Individual cost components were identified, measured and valued for the services of in-patient and outpatient care, laboratory processing and ambulance referrals. The cost to healthcare providers for one bed-day for a general paediatric medical admission was 18 at Zomba Central Hospital,50 at Kisumu County Referral Hospital, and 15 at Jinja Children’s Referral Hospital. When accounting for laboratory services, blood transfusions, and malaria medication for the duration of the entire hospital stay, the total costs of care were:118 in Zomba, 427 in Kisumu and167 in Jinja. At Kamuzu Central Hospital, a bed-day costs 9 in the main children’s medical ward, and24 in the High Dependency Unit. The costs of providing for the entire hospital admission were 79 and310, respectively. Personnel and operational costs were the main cost drivers for admissions costs, while laboratory supplies were the main cost component when providing blood testing services. This study demonstrates how the costs of providing health care are influenced by fixed and variable cost components, health service utilization, and country-specific investments in health care. Our findings contribute to an evidence base to inform resource allocation and cost-effectiveness analyses of interventions targeting severe anaemia and malaria in children in Malawi, Kenya, and Uganda. Registry: pactr.samrc.ac.za Date of Registration: 8th March 2023, Trial Registration Number: PACTR202303630742194.
Basic medical insurance is a key institutional arrangement for unlocking the latent consumption capacity of households in China. Drawing on panel data from the China Family Panel Studies (CFPS), this paper systematically examines the impact of basic medical insurance on household consumption and its underlying mechanisms. The study finds the following: Basic medical insurance has a significant positive effect on household consumption. Its mechanism of action is primarily manifested through three channels: first, the income effect, which improves residents’ health capital stock and enhances their earning capacity; second, the substitution effect, which reduces the uncertainty of out-of-pocket medical expenses and releases precautionary savings; and third, the trust effect, which strengthens residents’ institutional trust in the government and improves their future expectations. This study provides new micro-level evidence for understanding how universal social security systems unlock residents’ consumption potential, and offers targeted policy insights for deepening the reform of the basic medical insurance system and enhancing the precision and effectiveness of social security for the people.
