Household cost of out-patient treatment of Buruli ulcer in Ghana: a case study of Obom in Ga South Municipality

BMC Health Services Research

Moses Aikins²  Hannah Brown Amoakoh¹ 

[1] Senior Medical Officer, Department of Civilian and Military Polyclinics, 37 Military Hospital, Accra, Ghana;Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Accra, Ghana

关键词: Ghana;    Social isolation;    Cost burden;    Economic treatment cost;    Buruli ulcer;   

Others  :  1134502
DOI  :  10.1186/1472-6963-13-507

 received in 2013-05-13, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

The economic burden of diseases has become increasingly relevant to policy makers as healthcare expenditure keep rising in the face of limited and competing resources. Buruli ulcer (BU), a neglected but treatable tropical disease caused by Mycobacterium ulcerans, the only known environmental mycobacterium is capable of causing long term disability when left untreated. However, most BU studies have tended to focused on its bacteriology, epidemiology, entomology and other social determinants to the neglect of its economic evaluation. This paper reports estimated the household economic costs of BU and describe the intangible cost suffered by BU patients in an endemic area.

Methods

Retrospective one year cost data was used. A total of 63 confirmed BU cases were randomly sampled for the study. Economic cost and cost burden of BU were estimated. Sensitivity analysis was conducted to test the robustness of the cost estimates. Intangible cost measured stigmatization, pain, functional limitation and social isolation of children.

Results

The annual total household economic cost was US$35,915.98, of which about 65% was cost incurred by children with a mean cost of US$521.04. The mean annual household cost was US$570.09. The direct cost was 96% of the total cost. Non-medical cost accounts for about 97% of the direct cost with a mean cost of US$529.27. The mean medical cost was US$18.94. The main cost drivers of the household costs were transportation (78%) and food (12%). Caregivers and adult patients lost a total of 535 productive days seeking care, which gives an indirect cost valued at US$1,378.67 with a mean of US$21.88. A total of 365 school days (about 1 year) were lost by 19 BU patients (mean, 19.2 days). Functional loss and pain were low, and stigma rated moderate. Most children suffering from BU (84%) were socially isolated.

Conclusion

Household cost burden of out-patient BU ulcer treatment was high. Household cost of BU is therefore essential in the design of its intervention. BU afflicted children experience social isolation.

【 授权许可】

   
2013 Amoakoh and Aikins; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ackumey MM, Kwakye-Maclean C, Ampadu EO, de Savigny D, Weiss MG: Health services for buruli ulcer: lessons from a field study in Ghana. PLoS Negl Trop Dis 2011, 5(6):e1187. doi:10.1371/journal.pntd.0001187
• [2]Amofah G, Bonsu F, Tetteh C, Okrah J, Asamoa K, Asiedu K, Addy J: Buruli ulcer in Ghana: results of a national case search. Emerg Infect Dis 2002, 8(2):167-170. doi:10.3201/eid0802.010119
• [3]World Health Organization: Report of the 7th WHO advisory group meeting on Buruli ulcer. Geneva: WHO headquarters; [Internet]. 2012 Dec [cited 2012 Dec 10]. Available from: http://whqlibdoc.who.int/hq/2004/WHO_CDS_CPE_GBUI_2004.9.pdf webcite
• [4]World Health Organization: Buruli ulcer disease. Fact sheet No 199. [Internet]. 2011 Dec [cited 2011 Dec 15]. Available from http://www.who.int/mediacentre/factsheets/fs199/en/ webcite
• [5]Aiga H, Amano T, Cairncross S, Domako JA, Ofosu-Kwabi N, Coleman S: Assessing water related risk factors for buruli ulcer: a case–control study in Ghana. Am J Trop Med Hyg 2004, 71(4):387-392.
• [6]Asiedu K, Etuaful S: Socioeconomic implications of buruli ulcer in Ghana: a three year review. Am J Trop Med Hyg 1998, 59(6):1015-1022.
• [7]Johnson PDR: Should antibiotics be given for buruli ulcer? Lancet 2010, 375(6736):10.
• [8]Portaels F, Elsen P, Guimaraes-Peres A, Fonteyne P, Meyers WM: Insects in the transmission of Mycobacterium ulcerans infection. Lancet 1999, 353:986.
• [9]Walsh DS, Portaels F, Meyers WM: Buruli ulcer (Mycobacterium ulcerans infection). Trans R Soc Trop Med Hyg 2008, 102:969-978. doi:10.1016/j.trstmh.2008.06.006
• [10]Hotez PJ, Kamath A: Neglected tropical diseases in Sub-Saharan Africa: review of their prevalence, distribution, and disease burden. Neg Trop Dis 2009, 3(8):e412. doi:10.1371/journal.pntd.0000412
• [11]Nienhuis WA, Stienstra Y, Thompson WA, Awah PC, Abass KIM, Tuah W, Awua-Boateng NY, Ampadu EO, Siegmund V, Schouten JP, Adjei O, Brtetel G, van der werf TS: Antimicrobial treatment for early, limited Mycobacterium Ulcerans infection: A randomised controlled trial. Lancet 2010, 375(9715):664-672.
• [12]Johnson PDR, Stinear T, Small PLC, Plushke G, Merritt RW, Portaels F, Huygen K, Hayman JA, Asiedu K: Buruli ulcer (M. ulcerans infection): New insights, new hope for disease control. PLoS Medicine 2005, 2:282-286.
• [13]Amofah GK, Sagoe-Moses C, Adjei-Acquah C, Frimpong EH: Epidemiology of buruli ulcer in Amansie west district, Ghana. Trans R Soc Trop Med Hyg 1993, 87(6):644-645.
• [14]Renzaho AMN, Woods PV, Ackumey MM, Harvey SK, Kotin J: Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of Buruli ulcer in Ga West district, Ghana. Trop Med Int Health 2007, 12(3):445-458.
• [15]Grietens KP, Boock AU, Peeters H, Hausmann-Muela S, Toomer E, Ribera JM: “It is me who endures but my family that suffers”: social isolation as a consequence of the household cost burden of buruli ulcer free of charge hospital treatment. PloS Neg Trop Dis 2008, 2(10):e321. doi:10.1371/journal.pntd.0000321
• [16]Russell S: The economic burden of illness for households of developing countries: a review of studies focusing on malaria, tuberculosis and human immunodeficiency virus/ acquired immunodeficiency syndrome. Am J Trop Med Hyg 2004, 71(2):147-155.
• [17]Adamba C, Owusu YA: Burden of buruli ulcer: how affected households in a Ghanaian district cope. Afr Stud Monogr 2011, 32(1):1-23.
• [18]Casado V, Martinez-Yelanos S, Martinez-Yelamos A, Carmona O, Alonso L, Romero L, Moral E, Gubieras L, Arbizu T: Direct and indirect cost of multiple sclerosis in baix llobregat (Catalonia, Spain), according to disability. BMC Health Serv Res 2006., 6(143) doi:10.1186/1472-6963-6-143
• [19]Minden K, Niewerth N, Listing J, Biedermann T, Schontube M, Zink A: Burden and cost of illness in patients with juvenile idiopathic arthritis. Ann Rheum Dis 2004, 63:836-842. doi:10.1136/ard.2003.008516
• [20]Zhu TY, Tam L, Li EK: Societal cost of rheumatoid arthritis in Hong Kong: a prevalence based cost-of-illness study. Rheumatology 2011., 10(1093) doi:10.1093/rheumatology/ker014
• [21]Virta L, Joranger P, Brox JI, Eriksson R: Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskelet Disord 2012., 13(17) doi:10.1186/1471-2474-13-17
• [22]Stienstra Y, Dijkstra PU, Guedenon A, Johnson RC, Ampadu EO, Mensah T, Klutse EY, Etuaful S, Deepak S, van der Graaf WTA, van der Werf JS: Development of a questionnaire assessing Buruli ulcer-induced functional limitation. Am J Trop Med Hyg 2004, 70(3):318-322.
• [23]Stienstra Y, Dijkstra PU, Van Wezel MJ, van Roest MHG, Beets M, Zijlstra I, Johnson RC, Ampadu EO, Gbovi J, Zinson C, Etuaful S, Klutse EY, van der Graaf WTA, van der Werf TS: Reliability and validity of Buruli ulcer functional limitation score questionnaire. Am J Trop Med Hyg 2005, 72(4):449-452.
• [24]Stienstra Y, Winette TA, van de Graaf , Asamoa K, van de Werf TS: Beliefs and attitudes towards Buruli ulcer in Ghana. Am J Trop Med Hyg 2002, 67(2):207-213.
• [25]Cochran WG: Sampling techniques. 2nd edition. New York: John Wiley and Sons, Inc.; 1963.
• [26]Johns R: Likert items and scales. [Survey question bank: method fact sheet 1] [Internet]. 2012 Jun [cited 2012 Jun 19]. Available from: http://surveynet.ac.uk/sqb/datacollection/likertfactsheet.pdf webcite
• [27]Hawker GA, Mian S, Kendzerska T, French M: Measures of adult pain. Arthiritis Care Res 2011, 63(11):240-252.
• [28]Le TK, Montejano LB, Cao Z, Zhao Y, Ang D: Healthcare cost in US patients with and without a diagnosis of osteoarthritis. J Pain Res 2012, 5:23-30. doi:10.2147/JPR.S27275
• [29]Ackumey MM, Kwakye-Maclean C, Ampadu EO, de Savigny D, Weiss MG: Health Services for Buruli Ulcer Control: Lessons from a Field Study in Ghana. PLoS Neglected Tropical Diseases 2011., 5(6) doi:10.1371/journal.pntd.0001187