malaria; economic; cost; management; Peru; health care-seeking behaviour
Abstract :
[en] Background
Case management is one of the principal strategies for malaria control. This study aimed to estimate the economic costs of uncomplicated malaria case management and explore the influence of healthseeking behaviours on those costs.
Methods
A knowledge, attitudes and practices (KAP) survey was applied to 680 households of fifteen
communities in Mazan-Loreto in March 2017, then a socio-economic survey was conducted in
September 2017 among 161 individuals with confirmed uncomplicated malaria in the past three
months. Total costs per episode were estimated from both provider (Ministry of Health, MoH) and
patient perspectives. Direct costs were estimated using a standard costing estimation procedure, while the indirect costs considered the loss of incomes among patients, substitute labourers and companions due to illness in terms of the monthly minimum wage. Sensitivity analysis evaluated the uncertainty of the average cost per episode.
Results
The KAP survey showed that most individuals (79.3%) that had malaria went to a health facility for
a diagnosis and treatment, 2.7% received those services from community health workers, and 8% went to a drugstore or were self-treated at home. The average total cost per episode in the Mazan district was US$161. The cost from the provider’s perspective was US$30.85 per episode while from the patient’s perspective the estimated cost was US$ 131 per episode. The average costs per Plasmodium falciparum episode (US$180) were higher than those per Plasmodium vivax episode (US$156) due to longer time lost from work by patients with P. falciparum infections (22.2 days) than by patients with P. vivax infections (17.0 days). The delayed malaria diagnosis (after 48 hours of the onset of symptoms) was associated with the time lost from work due to illness (adjusted mean ratio 1.8; 95%CI 1.3, 2.6). The average cost per malaria episode was most sensitive to the uncertainty around the lost productivity cost due to malaria.
Conclusions: Despite the provision of free malaria case management by MoH, there is delay in seeking care and the costs of uncomplicated malaria are mainly borne by the families. These costs are not well perceived by the society and the substantial financial impact of the disease can be frequently undervalued in public policy planning
Disciplines :
Social economics Immunology & infectious disease
Author, co-author :
Moreno-Gutierrez, Diamantina
Rosas-Aguirre, Angel
Llanos-Cuentas, Alejandro
Bilcke, Joke
Barboza, Jose Luis
Hayette, Marie-Pierre ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Bactériologie, mycologie, parasitologie, virologie
Contreras-Mancilla, Juan
Aguirre, Kristian
Gamboa, Dionicia
Rodriguez, Hugo
Speybroeck, Niko
Beutels, Philippe
Language :
English
Title :
Economic costs analysis of uncomplicated malaria case management in the Peruvian Amazon
Alternative titles :
[en] Analyse du coût lié à la prise en charge des cas de paludisme non compliqué dans la région de l'amazone Péruvienne
Publication date :
21 April 2020
Journal title :
Malaria Journal
eISSN :
1475-2875
Publisher :
BioMed Central, United Kingdom
Volume :
19
Issue :
1
Pages :
161
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
ARES - Académie de Recherche et d'Enseignement Supérieur
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Bibliography
Huicho L, Segura ER, Huayanay-Espinoza CA, de Guzman JN, Restrepo-Méndez MC, Tam Y, et al. Child health and nutrition in Peru within an antipoverty political agenda: a countdown to 2015 country case study. Lancet Glob Health. 2016;4:e414-26.
United Nations. Transforming our world: the 2030 agenda for sustainable development. In: Rosa W, editors. A new era in global health. New York: Springer Publishing Company; 2017. http://connect.springerpub.com/lookup/doi/10.1891/9780826190123.ap02. Accessed 12 May 2019.
The World Bank. http://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2016&locations=PE&start=2000.
Petrera M, Valdivia M, Jimenez E, Almeida G. Equity in health and health care in Peru, 2004-2008. Rev Panam Salud Pública. 2013;33:131-6.
Ministerio de Salud. Dirección General de Epidemiología. Boletín Epidemiológico No 52. Lima: Peru; 2012. http://www.dge.gob.pe/boletines/2012/52.pdf. Accessed 1 Jun 2019.
Solano-Villarreal E, Valdivia W, Pearcy M, Linard C, Pasapera-Gonzales J, Moreno-Gutierrez D, et al. Malaria risk assessment and mapping using satellite imagery and boosted regression trees in the Peruvian Amazon. Sci Rep. 2019;9:15173.
Rosas-Aguirre A, Gamboa D, Manrique P, Conn JE, Moreno M, Lescano AG, et al. Epidemiology of Plasmodium vivax malaria in Peru. Am J Trop Med Hyg. 2016;95:133-44.
WHO. World malaria report 2018. Geneva: World Health Organization; 2018. http://www.who.int/malaria/publications/world-malaria-report-2018/report/en/. Accessed 18 Jan 2019.
Ministerio de Salud-Centro Nacional de Epidemiología, Prevención y Control de Enfermedades. Sala situacional de Salud. Report No. 52. Lima: Peru; 2017. http://www.dge.gob.pe/portal/index.php?option=com_content&view=article&id=606 Accessed 1 Jun 2019.
Chuquiyauri R, Paredes M, Peñataro P, Torres S, Marin S, Tenorio A, et al. Socio-demographics and the development of malaria elimination strategies in the low transmission setting. Acta Trop. 2012;121:292-302.
Ministerio de Salud. Proyecto Vigia. Impacto económico de la malaria en el Perú. Lima: Peru; 1999, p. 127. http://bvs.minsa.gob.pe/local/minsa/1763.pdf. Accessed 10 Jun 2019.
WHO. Global Health Workforce Alliance: Peru. Geneva, World Health Organization. http://www.who.int/workforcealliance/countries/per/en/. Accessed 22 Apr 2019.
Plan Esencial de Aseguramiento en Salud (PEAS). http://www.sis.gob.pe/asegurados/listado-de-cobertura.asp. Accessed 23 Apr 23 2019.
WHO. Primary health care systems (PRIMASYS): Case study from Peru, abridged version. Geneva: World Health Organization, 2017. http://www.who.int/alliance-hpsr/projects/alliancehpsr_peruabridgedprimasys.pdf?ua=1. Accessed 22 Apr 2019.
Seguro Integral de Salud - SIS. http://www.sis.gob.pe/asegurados/tipos-de-seguro/sis-gratuito.asp. Accessed 30 Apr 2019.
Instituto Nacional de Estadística e Informática. Mujeres y hombres con Seguro Integral de Salud (SIS), según ámbito geográfico. http://www.inei.gob.pe/buscador/?tbusqueda=seguro+integral+de+salud. Accessed 23 Apr 2019.
WHO. Disease surveillance for malaria elimination: operational manual. Geneva: World Health Organization, 2012. http://www.who.int/malaria/publications/atoz/9789241503334/en/. Accessed 30 Apr 2019.
Moreno-Gutierrez D, Llanos-Cuentas A, Luis Barboza J, Contreras-Mancilla J, Gamboa D, Rodriguez H, et al. Effectiveness of a malaria surveillance strategy based on active case detection during high transmission season in the Peruvian Amazon. Int J Environ Res Public Health. 2018;15:e2670.
Devine A, Kenangalem E, Burdam FH, Anstey NM, Poespoprodjo JR, Price RN, et al. Treatment-seeking behavior after the implementation of a unified policy of dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria in Papua, Indonesia. Am J Trop Med Hyg. 2018;98:543-50.
Ministerio de Salud. Factores de Riesgo de la Malaria Grave en el Perú. Lim: Peru; 2001. http://bvs.minsa.gob.pe/local/minsa/1772.pdf. Accessed 29 Apr 2019.
Parker BS, Paredes Olortegui M, Peñataro Yori P, Escobedo K, Florin D, Rengifo Pinedo S, et al. Hyperendemic malaria transmission in areas of occupation-related travel in the Peruvian Amazon. Malar J. 2013;12:178.
Establecimientos de Salud Loreto. ftp.minsa.gob.pe/sismed/establecimientos/disasdiresas/EESS%20-%20LORETO.xls. Accessed 11 Apr 2019.
WHO. Malaria Microscopy. Quality Assurance Manual. 2nd ed. Geneva: World Health Organization; 2016. http://www.who.int/malaria/publications/atoz/9789241549394/en/. Accessed 12 Apr 2019.
WHO. Prequalification of In Vitro Diagnostics. Geneva: World Health Organization. http://www.who.int/diagnostics_laboratory/evaluations/pq-list/malaria/190129_amended_pqpr_0297_012_00_v2.pdf. Accessed 11 Apr 2019.
Ministerio de Salud. Norma técnica para la atención de la malaria y malaria severa en el Perú. Iquitos: Peru; 2015. http://bvs.minsa.gob.pe/local/MINSA/4373.pdf. Accessed 13 Apr 2019.
Llanos-Cuentas A, Lacerda MV, Rueangweerayut R, Krudsood S, Gupta SK, Kochar SK, et al. Tafenoquine plus chloroquine for the treatment and relapse prevention of Plasmodium vivax malaria (DETECTIVE): a multicentre, double-blind, randomised, phase 2b dose-selection study. Lancet. 2014;383:1049-58.
Marquino W, Huilca M, Calampa C, Falconi E, Cabezas C, Naupay R, et al. Efficacy of mefloquine and a mefloquine-artesunate combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon Basin of Peru. Am J Trop Med Hyg. 2003;68:608-12.
Heggenhougen HK, Hackethal V, Vivek P. The behavioural and social aspects of malaria and its control. An introduction and annotated bibliography. Geneva: World Health Organization, 2003. http://apps.who.int/iris/handle/10665/42504. Accessed 13 Apr 2019.
Instituto Nacional de Estadística e Informática. Directorio de Comunidades Nativas y Campesinas. Censos Nacionales 2017, vol I. Lima: Peru; 2018. http://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1597/TOMO_01.pdf. Accessed 13 Apr 2019.
WHO. Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization; 2015, p. 316. http://www.who.int/malaria/publications/atoz/9789241549127/en/. Accessed 12 Apr 2019.
Ministerio de Salud. Documento Técnico "Metodología para la Estimación de Costos Estándar en los Establecimientos de Salud". Resolución Ministerial No 195-2009-MINSA. Lima: Peru; 2009. http://gestionensalud.medicina.unmsm.edu.pe/wp-content/uploads/2015/10/EVALUA_RB_05_DGSP_2006_Metodologia_Costeo.pdf.
Richardson SC, Hussmanns R, Mehran F, Verma V. Surveys of economically active population, employment, unemployment and underemployment. Statistician. 1992;41:249.
Instituto Nacional de Estadística e Informática. Indicadores de Empleo e Ingreso por departamento Perú 2007-2017. Lima: Peru; 2018. http://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1537/libro.pdf. Accessed 12 Apr 2019.
Decreto Legislativo No 854. Ley de Jornada de Trabajo, Horario y Trabajo en Sobretiempo. http://www.leyes.congreso.gob.pe/Documentos/DecretosLegislativos/00854.pdf. Accessed 12 Apr 2019.
Briggs A, Sculpher M, Claxton K. Decision Modelling for health economic evaluation. Oxford: New York; 2006. http://global.oup.com/academic/product/decision-modelling-for-health-economic-evaluation-9780198526629?cc=be&lang=en&. Accessed 13 Apr 2019.
Gray A, Clarke P, Wolstenholme J, Wordsworth S. Applied Methods of Cost-effectiveness Analysis in Healthcare. Oxford: New York; 2011. http://global.oup.com/academic/product/applied-methods-of-cost-effectiveness-analysis-in-healthcare-9780199227280?cc=be&lang=en&. Accessed 13 Apr 2019.
GDP per capita (current US$). Data. http://data.worldbank.org/indicator/ny.gdp.pcap.cd?locations=pe. Accessed 12 Apr 12 2019.
Sicuri E, Bardají A, Sanz S, Alonso S, Fernandes S, Hanson K, et al. Patients' costs, socio-economic and health system aspects associated with malaria in pregnancy in an endemic area of Colombia. PLoS Negl Trop Dis. 2018;12:e0006431.
Bôtto-Menezes C, Bardají A, Dos Santos Campos G, Fernandes S, Hanson K, Martínez-Espinosa FE, et al. Costs associated with malaria in pregnancy in the Brazilian Amazon, a low endemic area where Plasmodium vivax predominates. PLoS Negl Trop Dis. 2016;10:e0004494.
Karyana M, Devine A, Kenangalem E, Burdarm L, Poespoprodjo JR, Vemuri R, et al. Treatment-seeking behaviour and associated costs for malaria in Papua, Indonesia. Malar J. 2016;15:536.
Morel CM, Thang ND, Xa NX, Hung LX, Thuan LK, Van Ky P, et al. The economic burden of malaria on the household in south-central Vietnam. Malar J. 2008;7:166.
Van den Eede P, Soto-Calle VE, Delgado C, Gamboa D, Grande T, Rodriguez H, et al. Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study. PLoS ONE. 2011;6:e16257.
Chuquiyauri R, Peñataro P, Brouwer KC, Fasabi M, Calderon M, Torres S, et al. Microgeographical differences of Plasmodium vivax relapse and re-infection in the Peruvian Amazon. Am J Trop Med Hyg. 2013;89:326-38.
Russell S. The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg. 2004;71(Suppl 2):147-55.
Devine A. The economics of vivax malaria treatment. 2018 Aug 22. http://thesiscommons.org/zsc6x/. Accessed 16 Nov 2019.
Llanos-Chea F, Martínez D, Rosas A, Samalvides F, Vinetz JM, Llanos-Cuentas A. Characteristics of travel-related severe Plasmodium vivax and Plasmodium falciparum malaria in individuals hospitalized at a tertiary referral center in Lima, Peru. Am J Trop Med Hyg. 2015;93:1249-53.
Lima ISF, Duarte EC. Factors associated with timely treatment of malaria in the Brazilian Amazon: a 10-year population-based study. Pan Am J Public Health. 2017;41:e100.
Casapía M, Vásquez LE, Rosas Á, Pinedo-Ríos N, Cabezas C, Chang J. Mejora en el diagnóstico y tratamiento oportuno de malaria con el uso de pruebas rápidas por promotores de salud en la Amazonía Peruana. Rev Peru Med Exp Salud Publica. 2008;361-8.
Aguirre RAM, Zavalaga LLF, Belaunde TM. Cost-effectiveness ratio of using rapid tests for malaria diagnosis in the Peruvian Amazon. Rev Panam Salud Publica. 2009;25:377-88 (in Spanish).
Durand VS, Ramal AC, Huilca M, Cabezas SC. Oportunidad en el diagnóstico y tratamiento de la malaria en comunidades periurbanas de la amazonía peruana. Rev Peru Med Exp Salud Publica. 2005;22:47-53.
Giao PT, Vries PJ, Binh TQ, Nam NV, Kager PA. Early diagnosis and treatment of uncomplicated malaria and patterns of health seeking in Vietnam. Trop Med Int Health. 2005;10:919-25.
Grietens KP, Soto V, Erhart A, Ribera JM, Toomer E, Tenorio A, et al. Adherence to 7-day primaquine treatment for the radical cure of P. vivax in the Peruvian Amazon. Am J Trop Med Hyg. 2010;82:1017-23.
Adhikari B, Phommasone K, Pongvongsa T, Koummarasy P, Soundala X, Henriques G, et al. Treatment-seeking behaviour for febrile illnesses and its implications for malaria control and elimination in Savannakhet Province, Lao PDR (Laos): a mixed method study. BMC Health Serv Res. 2019;19:252.
Pigott DM, Atun R, Moyes CL, Hay SI, Gething PW. Funding for malaria control 2006-2010: a comprehensive global assessment. Malar J. 2012;11:246.
Durand S, Lachira-Alban A, Sánchez CC. Impact on the transmission of malaria with different treatment schemes in the peruvian coast and amazon region within the framework of a policy on antimalarial medications, 1994-2017. Rev Peru Med Exp Salud Publica. 2018;35:497-504 (in Spanish).
The Global Fund. Price & quality reporting price reference Report. http://public.tableau.com/profile/the.global.fund#!/vizhome/PQRPricelist_English/PriceList. Accessed 15 Oct 2019.
Recht J, Siqueira AM, Monteiro WM, Herrera SM, Herrera S, Lacerda MVG. Malaria in Brazil, Colombia, Peru and Venezuela: current challenges in malaria control and elimination. Malar J. 2017;16:273.
SIAPS. Informe técnico: Evaluación de la situación de la gestión del suministro de medicamentos antimaláricos en los países miembros de la Iniciativa para el Control de la Malaria en la Cuenca del Amazonas. Presentado a la Agencia de los Estados Unidos para el Desarrollo Internacional por el Programa Systems for Improved Access to Pharmaceuticals and Services (SIAPS). Arlington: Management Sciences for Health. 2015. http://apps.who.int/medicinedocs/es/m/abstract/Js21876es/. Accessed 10 May 2019.
Bouwmans CKM, Severens HKM, Brouwer WHRL. The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses. Value Health. 2015;8:753-8.
Monteiro WM, Val FF, Siqueira AM, Franca GP, Sampaio VS, Melo GC, et al. G6PD deficiency in Latin America: systematic review on prevalence and variants. Mem Inst Oswaldo Cruz. 2014;109:553-68.
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