Burke Rachel M, Rebolledo Paulina A, Embrey Sally R, Wagner Laura Danielle, Cowden Carter L, Kelly Fiona M, Smith Emily R, Iñiguez Volga, Leon Juan S
Hubert Department of Global Health, Emory University, Rollins School of Public Health, Mailstop 1518-002-7BB, 1518 Clifton Road NE, Claudia N Rollins Bldg, 6050, Atlanta, GA 30322, USA.
BMC Public Health. 2013 Aug 2;13:708. doi: 10.1186/1471-2458-13-708.
Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs.
From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (<5 years of age) seeking treatment for diarrhea in sentinel hospitals participating in Bolivia's diarrheal surveillance program across three main geographic regions. Data collected included demographics, clinical symptoms, direct costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages).
Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (p<0.05) when stratified on appointment type. Direct, indirect, and total costs to families were significantly higher for inpatients as compared to outpatients of urban (p<0.001) and rural (p<0.05) residence. Consult fees and indirect costs made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden.
This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.
在全球范围内，急性肠胃炎对五岁以下儿童构成了巨大的公共卫生威胁，每年导致10亿例发病以及190万至320万例死亡。在南美洲国内生产总值较低的玻利维亚，估计15%的五岁以下儿童死亡是由腹泻造成的。由于五岁以下儿童可享受全民健康保险，据信玻利维亚家庭在腹泻相关方面的支出极少。本报告的目的是描述照顾者为小儿肠胃炎寻求治疗所产生的总成本和成本负担，并量化成本、成本负担、治疗环境以及成本认知之间的关系。
2007年至2009年期间，研究人员对参与玻利维亚腹泻监测项目的三个主要地理区域的定点医院中因腹泻就诊的小儿患者（<5岁）的照顾者（n = 1107）进行了访谈。收集的数据包括人口统计学信息、临床症状、直接成本（如药物、诊疗费）和间接成本（如工资损失）。
就性别、病程和年龄而言，各城市的患者群体相似，但根据预约类型分层时，家庭收入差异显著（p<0.05）。与城市（p<0.001）和农村（p<0.05）地区的门诊患者相比，住院患者家庭的直接、间接和总成本要高得多。诊疗费和间接成本在总成本中占很大比例。45%的患者家庭因这一次腹泻发作支付了≥1%的家庭年收入。实际成本负担较高的人群中，认为成本影响家庭财务状况的情况更为常见。
本研究表明，急性小儿腹泻造成的间接成本是家庭产生的总成本的重要组成部分。此外，单次腹泻发作的家庭成本影响了大量照顾者的实际和感知财务状况。这些数据为轮状病毒疫苗实施之前和之后的社会腹泻成本提供了基线，并突出了腹泻发作对玻利维亚照顾者的严重经济重要性。
