Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa

Background South Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector. Method Qualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed. Results This study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly. Conclusion This was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.

Country-level Association of Socioeconomic, Environmental and Healthcare-Related Factors with the Disease-Burden and Mortality Rate of COVID-19

BackgroundCOVID-19 pandemic is rapidly expanding throughout the world right now. Caused by a novel strain of the coronavirus, the manifestation of this pandemic shows a unique level of disease burden and mortality rate in different countries.ObjectiveIn this paper, we investigated the effects of several socioeconomic, environmental, and healthcare-related factors on the disease burden and mortality rate of COIVID-19 across countries. Our main objective is to provide a macro-level understanding of the most influential socioeconomic, environmental, and healthcare-related factors associated with the disease burden and mortality rate metrics without human bias.MethodsWe developed a multiple linear regression model using backward elimination to find the best fitting between reported death and cases across countries for country-level aggregated independent factors keeping COVID-19 test statistic in consideration. Notably, the method requires minimum human intervention and handles confounding effects intrinsically.ResultsOur results show that while the COVID-19 pandemic is seemingly spreading more rapidly in economically affluent countries, it Is more deadly in countries with inadequate healthcare infrastructure, lower capacity of handling epidemics, and lower allocation of the healthcare budget. We also did not find evidence of any association between environmental factors and COVID-19.ConclusionWe took the number of tests performed into account and normalized the case and mortality counts based on the cumulative distribution of cases across days. Our analysis of the standardized factors provides both the direction and relative importance of different factors leading to several compelling insights into the most influential socioeconomic and healthcare infrastructure-related factors from a country-level view.

A quality of life for patients with diabetes

Introduction and purpose: Diabetes mellitus (DM) is a metabolic disease caused by a chronic state of hyperglycemia, which results from a defect in the function or secretion of endogenous insulin. It is a disease that leads to serious complications such as blindness, lower limb amputation, ischemic heart disease or ischemic strokes. Description of the state of knowledge: The World Health Organization has identified diabetes mellitus as a global epidemic. Between 1980 and 2014, the number of people with diabetes increased from 108 million to over 422. Between 2000 and 2016, more than 7 million deaths from diabetes were reported in 108 countries, but this is an under-number due to the fact that many patients are not diagnosed with diabetes. The prevalence of diabetes in recent years is also higher in low and middle income (LMIC) countries than in high income (HIC) countries. DM also places a significant financial burden on the healthcare budget. Despite relatively large investments in medical care, clinical trials and public health interventions do not reduce the rate of increase in incidence. In the United States, annual healthcare expenditure for people with diabetes is 2.3 times greater than for people without diabetes.Summary: It is well known that diabetes significantly reduces patients' quality of life. It is influenced by both severe complications related to DM and adherence to strict medical recommendations. The low quality of life of diabetic patients contributes to depression, which is associated with not compliance with medical recommendations and increased mortality.

Economic assessment of incorporating the Hexavalent vaccine as part of the National Immunization Program of Peru

Background This study aimed to estimate the economic impact of replacing the current Peruvian primary immunization scheme for infants under 1 year old with an alternative scheme with similar efficacy, based on a hexavalent vaccine. Methods A cost-minimization analysis compared the costs associated with vaccine administration, adverse reactions medical treatment, logistical activities, and indirect social costs associated with time spent by parents in both schemes. A budgetary impact analysis assessed the financial impact of the alternative scheme on healthcare budget. Results Incorporating the hexavalent vaccine would result in a 15.5% net increase in healthcare budget expenditure ($48,281,706 vs $55,744,653). Vaccination costs would increase by 54.1%, whereas logistical and adverse reaction costs would be reduced by 59.8% and 33.1%, respectively. When including indirect social costs in the analysis, the budgetary impact was reduced to 8.7%. Furthermore, the alternative scheme would enable the liberation of 17.5% of national vaccines storage capacity. Conclusions Despite of the significant reduction of logistical and adverse reaction costs, including the hexavalent vaccine into the National Immunization Program of Peru in place of the current vaccination scheme for infants under 1 year of age would increase the public financial budget of the government as it would represent larger vaccine acquisition costs. Incorporating the indirect costs would reduce the budgetary impact demonstrating the social value of the alternative scheme. This merits consideration by government bodies, and future studies investigating such benefits would be informative.

Medical Costs of Children Admitted to the Neonatal Intensive Care Unit: the Role and Possible Economic Impact of WES in Early Diagnosis

Objective: The objective of this study is to provide an overview of average healthcare costs for patients admitted to the Neonatal Intensive Care Unit (NICU) and to assess possible impact of implementing Whole Exome Sequencing (WES) on these total healthcare costs.Methods: We retrospectively collected postnatal healthcare data of all patients admitted to the level IV NICU at the Radboudumc (October 2013-October 2015) and linked unit costs to these healthcare consumptions. Average healthcare costs were calculated and a distinction between patients was made based on performance of genetic tests and the presence of congenital anomalies (CAs).Results: Overall, €26,627 was spend per patient. Genetic costs accounted for 2.3% of all costs. Healthcare costs were higher for patients with CAs compared to patients without CAs. Patients with genetic diagnostics were also more expensive then patients without genetic diagnostics. When performing trio-WES for all patients instead of current diagnostics, overall healthcare costs will increase with 22.2%. In case only patients with CAs receive trio-WES, average per patient healthcare costs will increase with 5.3%. Performing trio-WES only for patients with multiple CAs did not result in any cost changes.Conclusions: Genetic diagnostic testing accounted for a small fraction of total costs. By implementing trio-WES as genetic diagnostic test for all patients with CAs there is a limited increase in overall healthcare budget. Not only the diagnostic yield of this cohort will increase, but implementing trio-WES for all patients with CAs may also allow for improved personalized treatments options guided by the diagnoses made.

The Importance of the World Kidney Day World Kidney Day – 11 March 2021 – Living Well with Kidney Disease

World Kidney Day (WKD) is a global campaign to raise awareness of the importance of our kidneys to overall health and to reduce the frequency and impact of kidney disease and associated health problems worldwide. Kidney disease is a non-communicable disease (NCD) and currently affects around 850 million people worldwide. One in ten adults has chronic kidney disease (CKD). The global burden of CKD is increasing, and is projected to become the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume 2–3% of the annual healthcare budget in high-income countries. Crucially, kidney disease can be prevented and progression to end-stage kidney disease can be delayed with appropriate access to basic diagnostics and early treatment. This year World Kidney Day continues to raise awareness of the increasing burden of kidney diseases worldwide and to strive for kidney health for everyone, everywhere. During the pandemic with COVID 19 patients kidneys are also damaged, apart from the respiratory tract and other organs. It can lead to an increase in acute renal failure and consequent chronic kidney insufficiency, as well as number of deaths. Therefore, it is important to evaluate the renal function in each patient with COVID 19 virus. In the Republic of North Macedonia from 2006 to present day nephrologists and other medical personnel devoted to the early diagnosis, prevention and treatment of renal disease have participated in the activities of the World Kidney Day. These activities were supported by the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, the Department of Nephrology at the Medical Faculty, the Macedonian Academy of Sciences and Arts, the Government of the Republic of North Macedonia, non-governmental nephrology organizations (NEFRON) and the media. There were lectures and presentation devoted to the various theme of the WKD, publications in journals, as well as activities for examination of the renal function of patients in the medical centers. The activities during the WKD contributed to the improvement of the nephrological protection of the citizens of the Republic of N. Macedonia.

Implementation of an Evidence-Based Practice Discharge Medication Protocol for Heart Failure Patients to Reduce 30-Day Readmissions

Practice Problem: An estimated 6.5 million American adults ≥20 years of age have heart failure (HF) and worldwide 1 to 2% of the total healthcare budget is spent on HF. To improve outcomes and streamline the treatment of HF patients, The American Heart Association (AHA) joined with the American College of Cardiology (ACC) and created the Get With The Guidelines Program (GWTG). PICOT: The PICOT question that guided this project was in adult HF patients admitted to the cardiovascular unit under the care of the hospitalist service, does implementing an evidence-based practice (EBP) discharge medication protocol for physician use based on the AHA GWTG program’s HF discharge medication protocol, compared to no standardized discharge protocol, improve patients’ 30-day readmission rate, in 12 weeks? Evidence: Evidence from 10 studies supported implementing an evidence-based GDMT tool into a standardized HF discharge medication protocol for this project. Intervention: Education and encouragement of use of the AHA GWTG discharge medication protocol for HF in the electronic health record (EHR) was provided to a group of physicians on a cardiovascular unit. The intervention was over a four-week period and pre- and post-intervention protocol use was observed with specific measures analyzed for observation of improvement. Outcome: The results determined there was minimal statistical significance, however, there was a decrease in the financial measure of the cost of HF readmissions denoting a clinical significance. Conclusion: Continued use of a guideline-based discharge medication protocol, such as the one utilized in this project, is recommended based on the results and evidence provided in this project.

ON DIFFERENTIATION OF HEALTHCARE BUDGET FINANCING OF THE CENTRAL FEDERAL DISTRICT REGIONS

The issue of financial support for the healthcare industry today is one of the most urgent and complex, which is caused by the peculiarities of the healthcare system. The existing model of financial support for the industry is recognized as imperfect and requires modernization. However, improving the financial provision of health care faces a number of challenges at every stage from accumulation to targeted use of funds. As a result, the amount of healthcare funding in Russia is one of the lowest in comparison with developed countries, which have a high level of medical development, and has a significant differentiation. In the course of the study, a comparative analysis of the volume of budget financing of health care in the regions of the Central Federal district was carried out, and current trends and their causes were identified. It is established that at present there is a significant differentiation in the level of budget financing of the healthcare industry, which is also accompanied by a reduction in the volume of incoming financial resources in most regions. At the same time, the largest amount of budget expenditures falls on Moscow - 183.7 billion rubles, which is 53.4% of the total amount of healthcare funding in the Central Federal district and 19.3% in the Russian Federation as a whole. The second place is taken by the Moscow region, whose share in the total volume of industry financing in the Central Federal district in 2018 was 23.2%, and in the Russian Federation - 8.4%. Thus, the capital region accounts for about 76.6% of the total budget expenditures on healthcare in the Central Federal district.

An efficient routing protocol for internet of medical things focusing hot spot node problem

The healthcare budget is increasing day-by-day as the population of the world increases. The same is the case regarding the workload of health care workers, that is, doctors and other practitioners. Under such a scenario where workload and cost are increasing drastically, there is a dire need of integrating recent technological enhancements with the said domain. Since the last decade, a lot of work is in the process considering the said integration bringing revolutionary changes. For remote monitoring, existing systems use different types of Internet of things devices that measure different health parameters. One of the major problems in such a system is to find an optimum routing approach that can resolve energy and thermal issues that are taking the limelight in the research arena. In this article, a dynamic routing technique is proposed which is keen to connect multiple in vivo/ex vivo Internet of things devices and a sink (focusing thermal and energy problem) and then forwarding data from sink to remote location for monitoring. Performance parameters are kept energy efficiency and thermal awareness and analytical results show that the proposed protocol supersedes existing approaches in said metrics.