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Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597643/ https://www.ncbi.nlm.nih.gov/pubmed/31321086 http://dx.doi.org/10.1136/bmjgh-2019-001449 |
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author | Eberly, Lauren Anne Rusangwa, Christian Ng'ang'a, Loise Neal, Claire C Mukundiyukuri, Jean Paul Mpanusingo, Egide Mungunga, Jean Claude Habineza, Hamissy Anderson, Todd Ngoga, Gedeon Dusabeyezu, Symaque Kwan, Gene Bavuma, Charlotte Rusingiza, Emmanual Mutabazi, Francis Mucumbitsi, Joseph Gahamanyi, Cyprien Mutumbira, Cadet Park, Paul H Mpunga, Tharcisse Bukhman, Gene |
author_facet | Eberly, Lauren Anne Rusangwa, Christian Ng'ang'a, Loise Neal, Claire C Mukundiyukuri, Jean Paul Mpanusingo, Egide Mungunga, Jean Claude Habineza, Hamissy Anderson, Todd Ngoga, Gedeon Dusabeyezu, Symaque Kwan, Gene Bavuma, Charlotte Rusingiza, Emmanual Mutabazi, Francis Mucumbitsi, Joseph Gahamanyi, Cyprien Mutumbira, Cadet Park, Paul H Mpunga, Tharcisse Bukhman, Gene |
author_sort | Eberly, Lauren Anne |
collection | PubMed |
description | BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease. METHODS: A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined. RESULTS: A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing. CONCLUSIONS: This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems. |
format | Online Article Text |
id | pubmed-6597643 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65976432019-07-18 Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda Eberly, Lauren Anne Rusangwa, Christian Ng'ang'a, Loise Neal, Claire C Mukundiyukuri, Jean Paul Mpanusingo, Egide Mungunga, Jean Claude Habineza, Hamissy Anderson, Todd Ngoga, Gedeon Dusabeyezu, Symaque Kwan, Gene Bavuma, Charlotte Rusingiza, Emmanual Mutabazi, Francis Mucumbitsi, Joseph Gahamanyi, Cyprien Mutumbira, Cadet Park, Paul H Mpunga, Tharcisse Bukhman, Gene BMJ Glob Health Research BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease. METHODS: A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined. RESULTS: A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing. CONCLUSIONS: This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems. BMJ Publishing Group 2019-06-17 /pmc/articles/PMC6597643/ /pubmed/31321086 http://dx.doi.org/10.1136/bmjgh-2019-001449 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Research Eberly, Lauren Anne Rusangwa, Christian Ng'ang'a, Loise Neal, Claire C Mukundiyukuri, Jean Paul Mpanusingo, Egide Mungunga, Jean Claude Habineza, Hamissy Anderson, Todd Ngoga, Gedeon Dusabeyezu, Symaque Kwan, Gene Bavuma, Charlotte Rusingiza, Emmanual Mutabazi, Francis Mucumbitsi, Joseph Gahamanyi, Cyprien Mutumbira, Cadet Park, Paul H Mpunga, Tharcisse Bukhman, Gene Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title_full | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title_fullStr | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title_full_unstemmed | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title_short | Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda |
title_sort | cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural rwanda |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597643/ https://www.ncbi.nlm.nih.gov/pubmed/31321086 http://dx.doi.org/10.1136/bmjgh-2019-001449 |
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