Patterson Jenna, Cleary Susan, Silal Sheetal P, Hussey Gregory D, Enoch Annabel, Korsman Stephen, Goddard Elizabeth, Setshedi Mashiko, Spearman Wendy C, Kagina Benjamin M, Muloiwa Rudzani
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
BMC Infect Dis. 2022 Jan 11;22(1):45. doi: 10.1186/s12879-021-06993-w.
While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines.
To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa.
We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018.
In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients [Formula: see text] 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and $563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver.
More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending.
虽然已有一些证据证明在中等收入国家常规接种甲型肝炎疫苗具有成本效益，但在包括南非在内的其他地区，相关证据仍然有限。鉴于此，需要建立关于甲型肝炎治疗成本的证据基础，以便考虑将甲型肝炎疫苗纳入国家免疫规划和指南。
描述南非开普敦两家三级医疗中心收治的甲型肝炎病例的严重程度、临床结局和成本。
我们对南非开普敦大都市城市社区提供护理的两家三级医院收治的甲型肝炎患者进行了回顾性病历审查。纳入本次病历审查的患者在2008年1月1日至2018年3月1日期间甲型肝炎免疫球蛋白M检测呈阳性。
本研究共纳入239份15岁以下甲型肝炎儿科患者病历和212份15岁及以上甲型肝炎成人患者病历。在接受三级护理之前，超过一半的患者在社区诊所或全科医生处进行了首次咨询。成人患者的平均住院时间为7.45天，儿科患者为3.11天。研究人群中有3名成年患者因甲型肝炎感染死亡，29名发生了复杂型甲型肝炎。研究人群中有1名儿科患者因甲型肝炎感染死亡，27名发生了复杂型甲型肝炎，其中4名儿科患者被诊断为急性肝衰竭。成人甲型肝炎住院患者的总费用为1935.41美元，儿科患者为563.06美元，住院时间决定的间接费用是最大的成本驱动因素。
本研究中每10例甲型肝炎病例中就有超过1例（13.3%）发生了复杂型甲型肝炎或导致死亡。鉴于临床结局的严重性以及与甲型肝炎住院相关的高成本，考虑在南非公共部门引入甲型肝炎免疫接种以潜在避免未来的发病、死亡和医疗支出非常重要。
