Nyaya Health Nepal, Kathmandu, Nepal.
2Department of Global Health, University of Washington, Seattle, WA USA.
Glob Health Res Policy. 2020 Jan 29;5:2. doi: 10.1186/s41256-020-0130-2. eCollection 2020.
Low- and middle-income countries are facing an increasing burden of disability and death due to cardiovascular diseases. Policy makers and healthcare providers alike need resource estimation tools to improve healthcare delivery and to strengthen healthcare systems to address this burden. We estimated the direct medical costs of primary prevention, screening, and management for cardiovascular diseases in a primary healthcare center in Nepal based on the Global Hearts evidence based treatment protocols for risk-based management.
We adapted the World Health Organization's non-communicable disease costing tool and built a model to predict the annual cost of primary CVD prevention, screening, and management at a primary healthcare center level. We used a one-year time horizon and estimated the cost from the Nepal government's perspective. We used Nepal health insurance board's price for medicines and laboratory tests, and used Nepal government's salary for human resource cost. With the model, we estimated annual incremental cost per case, cost for the entire population, and cost per capita. We also estimated the amount of medicines for one-year, annual number of laboratory tests, and the monthly incremental work load of physicians and nurses who deliver these services.
For a primary healthcare center with a catchment population of 10,000, the estimated cost to screen and treat 50% of eligible patients is USD21.53 per case and averages USD1.86 per capita across the catchment population. The cost of screening and risk profiling only was estimated to be USD2.49 per case. At same coverage level, we estimated that an average physician's workload will increase annually by 190 h and by 111 h for nurses, i.e., additional 28.5 workdays for physicians and 16.7 workdays for nurses. The total annual cost could amount up to USD18,621 for such a primary healthcare center.
This is a novel study for a PHC-based, primary CVD risk-based management program in Nepal, which can provide insights for programmatic and policy planners at the Nepalese municipal, provincial and central levels in implementing the WHO Global Hearts Initiative. The costing model can serve as a tool for financial resource planning for primary prevention, screening, and management for cardiovascular diseases in other low- and middle-income country settings globally.
中低收入国家正面临着因心血管疾病而导致的残疾和死亡人数不断增加的问题。政策制定者和医疗保健提供者都需要资源估算工具来改善医疗服务，并加强医疗保健系统以应对这一负担。我们根据全球心脏循证治疗方案对基于风险的管理，估算了尼泊尔一个初级保健中心进行心血管疾病一级预防、筛查和管理的直接医疗成本。
我们改编了世界卫生组织的非传染性疾病成本核算工具，并建立了一个模型，以预测初级心血管疾病一级预防、筛查和管理在初级保健中心层面的年度成本。我们使用了一年的时间范围，并从尼泊尔政府的角度估算了成本。我们使用了尼泊尔医保委员会的药品和实验室检测价格，并使用了尼泊尔政府的人力资源成本。通过该模型，我们估算了每个病例的年度增量成本、整个人群的成本和人均成本。我们还估算了一年的药物用量、每年的实验室检测次数，以及提供这些服务的医生和护士的每月增量工作量。
对于一个拥有 10000 名居民的初级保健中心，估计筛查和治疗 50%符合条件的患者的成本为每个病例 21.53 美元，整个患者群体的平均人均成本为 1.86 美元。仅进行筛查和风险评估的成本估计为每个病例 2.49 美元。在相同的覆盖水平下，我们估计平均医生的工作量将每年增加 190 小时，护士的工作量将增加 111 小时，即医生增加 28.5 个工作日，护士增加 16.7 个工作日。这样一个初级保健中心的年总成本可能高达 18621 美元。
这是尼泊尔首个基于初级保健的初级心血管疾病基于风险的管理方案的研究，可以为尼泊尔市、省和中央各级的规划人员和政策制定者在实施世卫组织全球心脏倡议方面提供参考。该成本核算模型可以作为在其他中低收入国家进行心血管疾病一级预防、筛查和管理的财务资源规划工具。
