International Journal of Environmental Research and Public Health

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10 pages, 1380 KiB

Open AccessArticle

Cost Consequence Analysis of Belimumab versus Standard of Care for the Management of Systemic Lupus Erythematosus in Saudi Arabia: A Retrospective Cohort Study

by Aseel Alsuwayegh, Ibrahim A. Almaghlouth, Majed Ali Almasaoud, Abdullah Sulaiman Alzaid, Adel Abdulaziz Alsuhaibani, Lyan Hassan Almana, Sara Mohammed Alabdulkareem, Joud Abdullah Abudahesh and Yazed AlRuthia

Int. J. Environ. Res. Public Health 2023, 20(3), 1917; https://doi.org/10.3390/ijerph20031917 - 20 Jan 2023

Cited by 2 | Viewed by 2861

Abstract

Background: Belimumab use for the management of systemic lupus erythematosus (SLE) has been limited, in part due to its high acquisition cost relative to the standard of care (SoC) and the uncertainties about its cost-effectiveness. Therefore, the aim of this study was to [...] Read more.

Background: Belimumab use for the management of systemic lupus erythematosus (SLE) has been limited, in part due to its high acquisition cost relative to the standard of care (SoC) and the uncertainties about its cost-effectiveness. Therefore, the aim of this study was to compare the cost and effectiveness of belimumab versus the SoC alone for the management of SLE using real-world data from the perspective of public healthcare payers in Saudi Arabia. Methods: Data were retrieved from a national prospective cohort of SLE, Saudi Arabia. Adult SLE patients (≥18 yrs.) treated with belimumab plus the SoC or the SoC alone for at least six months were recruited. The effectiveness was measured using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Unit costs for health services and prescription drugs were retrieved from the Saudi ministry of health. Nonparametric bootstrapping with inverse probability weighting was conducted to generate the 95% confidence limits for the cost and effectiveness. Results: A total of 15 patients on belimumab plus the SoC and 41 patients on the SoC alone met the inclusion criteria and were included in the analysis. The majority of patients were females (91.07%) with a mean age of 38 years. The mean difference in cost and SLEDAI-2K score reduction between belimumab versus the SoC were USD 5303.16 [95% CI: USD 2735.61–USD 7802.52] and 3.378 [95% CI: 1.769–6.831], respectively. Belimumab demonstrated better effectiveness but higher cost in 96% of the bootstrap cost-effectiveness distributions. Conclusion: Future studies should use more robust research designs and a larger sample size to confirm the findings of this study. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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13 pages, 319 KiB

Open AccessArticle

Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

by Ilir Hoxha, Besim Guda, Ali Hoti, Esra Zhubi, Erza Selmani, Blerta Avdiu, Jakob Cegllar, Dorjan Marušič and Aferdita Osmani

Int. J. Environ. Res. Public Health 2022, 19(22), 14638; https://doi.org/10.3390/ijerph192214638 - 8 Nov 2022

Cited by 1 | Viewed by 2425

Abstract

Background: Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo. Objective: To assess the clinical decision-making related to heart [...] Read more.

Background: Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo. Objective: To assess the clinical decision-making related to heart failure diagnosis by evaluating clinicians’ preferences for clinical attributes. Method: Conjoint analysis with 33 clinical scenarios with physicians employed in public hospitals in Kosovo. Setting: Two public hospitals in Kosovo that benefited from quality improvement intervention. Participants: 14 physicians (internists and cardiologists) in two hospitals in Kosovo. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision for heart failure diagnosis. Results: When considering clinical signs, the likelihood of a heart failure diagnosis increased for ages between 60 to 69 years old (RRR, 1.88; CI 95%, 1.05–3.34) and a stable heart rate (RRR, 1.93; CI 95%, 1.05–3.55) and decreased for the presence of edema (RRR, 0.23; CI 95%, 0.15–0.36), orthopnea (RRR, 0.31; CI 95%, 0.20–0.48), and unusual fatigue (RRR, 0.61; CI 95%, 0.39–0.94). When considering clinical examination findings, the likelihood for heart failure diagnosis decreased for high jugular venous pressure (RRR, 0.49; CI 95%, 0.32–0.76), pleural effusion (RRR, 0.35; CI 95%, 0.23–0.54), hearing third heart sound, (RRR, 0.50; CI 95%, 0.33–0.77), heart murmur (RRR, 0.57; CI 95%, 0.37–0.88), troponin levels (RRR, 0.59; CI 95%, 0.38–0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24–0.56). Conclusions: We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

8 pages, 307 KiB

Open AccessCommunication

Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis

by Ilir Hoxha, Bajram Duraj, Shefki Xharra, Afrim Avdaj, Valon Beqiri, Krenare Grezda, Erza Selmani, Blerta Avdiu, Jakob Cegllar, Dorjan Marušič and Aferdita Osmani

Int. J. Environ. Res. Public Health 2022, 19(21), 14027; https://doi.org/10.3390/ijerph192114027 - 28 Oct 2022

Cited by 3 | Viewed by 2107

Abstract

Objective: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. Method: A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. Setting: [...] Read more.

Objective: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. Method: A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. Setting: The study was conducted at two public hospitals in Kosovo that have benefited from quality-improvement interventions. Participants: The participants included 22 surgeons. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision to perform appendectomy and make the preoperative preparations for appendectomy. Results: In the regression analyses, several attributes demonstrated statistically significant effects on the clinical decision to perform appendectomy and on the practice of preoperative preparation. Conclusions: We found that several factors influenced the decision to perform appendectomy and the practices for preoperative preparation. Nevertheless, the small sample size limited our efforts to interpret the results. These findings could assist Kosovo in the design and implementation of future similar studies and in fostering quality improvement measures that address clinical decision making and the lack of process standardization in the delivery of surgical care. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

11 pages, 320 KiB

Open AccessArticle

Economic Analysis of Patient’s Own Medication, Unit-Use and Ward Stock Utilization: Results of the First Pilot Study

by Hamimatul Hayat Abdul Nasir, Hui Poh Goh, Daniel Vui Teck Wee, Khang Wen Goh, Kah Seng Lee, Andi Hermansyah, Yaser Mohammed Al-Worafi and Long Chiau Ming

Int. J. Environ. Res. Public Health 2022, 19(18), 11350; https://doi.org/10.3390/ijerph191811350 - 9 Sep 2022

Cited by 1 | Viewed by 1896

Abstract

Background: Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient’s own medications (POM) has proven to reduce wastage and save the cost spent by [...] Read more.

Background: Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient’s own medications (POM) has proven to reduce wastage and save the cost spent by the hospital. The potential benefits of using POM in inpatient settings have yet to be explored in a country with universal health coverage. This study aimed to pilot test the POM intervention in an adult ward setting and to perform the economic analysis of using POM and ward stock during hospitalization. Methods: A prospective cross-sectional observational study was conducted among the patients admitted to the medical and surgical wards in a public hospital located in Brunei Darussalam between February 2022 and April 2022. Hospitalized adults above 18 years old with regular medications with a minimum length of stay of 48 h and a maximum length of stay of 21 days were included in the study. These eligible patients were divided into a POM group and a non-POM group. The economic analysis of using POM was performed by calculating the direct cost per unit of medication used during admission (from unit-use, ward stock and POM) and comparing the cost spent for both groups. Expired ward stock deemed as medication wastage was determined. Medical research ethics were approved, and all participating patients had given their written informed consent before enrolling in this study. Results: A total of 112 patients aged 63.2 ± 15.8 years participated in this study. The average cost of medication supplied by the inpatient pharmacy for the non-POM group was USD 21.60 ± 34.20 per patient, whereas, for the POM group, it was approximately USD 13.00 ± 18.30 per patient, with a mean difference of USD 8.60 ± 5.17 per patient (95% CI: −3.95, 27.47, p ≥ 0.05). The use of POM minimized 54.03% (USD 625.04) of the total cost spent by the hospital for the POM group within the period of the study. Conclusion: The pilot study showed that the supplied medication cost per patient was not significantly different between the POM and non-POM groups. Nevertheless, the utilization of POM during hospitalization is capable of reducing at least 50% of the total cost spent on inpatient medications by the hospital. The use of POM during hospitalization also helped in reducing the total time spent on the medication process per patient. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

11 pages, 801 KiB

Open AccessArticle

Real-World Comparative Cost-Effectiveness Analysis of Different Classes of Disease-Modifying Therapies for Relapsing-Remitting Multiple Sclerosis in Saudi Arabia

by Yazed AlRuthia, Bander Balkhi, Sahar Abdullah Alkhalifah, Salman Aljarallah, Lama Almutairi, Miteb Alanazi, Abdulmalik Alajlan, Suliman M. Aldhafiri and Nuha M. Alkhawajah

Int. J. Environ. Res. Public Health 2021, 18(24), 13261; https://doi.org/10.3390/ijerph182413261 - 16 Dec 2021

Cited by 5 | Viewed by 3663

Abstract

The very fact that multiple sclerosis (MS) is incurable and necessitates life-long care makes it one of the most burdensome illnesses. The aim of this study was to compare the cost-effectiveness of orally administered medications (e.g., fingolimod, dimethyl fumarate, and teriflunomide), interferon (IFN)-based [...] Read more.

The very fact that multiple sclerosis (MS) is incurable and necessitates life-long care makes it one of the most burdensome illnesses. The aim of this study was to compare the cost-effectiveness of orally administered medications (e.g., fingolimod, dimethyl fumarate, and teriflunomide), interferon (IFN)-based therapy, and monoclonal antibodies (MABs) (e.g., natalizumab and rituximab) in the management of relapsing-remitting multiple sclerosis (RRMS) in Saudi Arabia using real-world data. This was a retrospective cohort study in which patients with RRMS aged ≥18 years without any other chronic health conditions with non-missing data for at least 12 months were recruited from the electronic health records of a university-affiliated tertiary care center. Multiple logistic regressions controlling for age, sex, and duration of therapy were conducted to examine the odds of disability progression, clinical relapse, MRI lesions, and composite outcome (e.g., relapse, lesion development on MRI, disability progression). The number of patients who met the inclusion criteria and were included in the analysis was 146. Most of the patients were female (70.51%) and young (e.g., ≤35 years of age). There were 40 patients on the orally administered agents (e.g., dimethyl fumarate, teriflunomide, fingolimod), 66 patients were on IFN-based therapy (e.g., Rebif^®), and 40 patients were on monoclonal antibodies (e.g., rituximab and natalizumab). Patients on MABs had lower odds of the composite outcome (OR = 0.17 (95% CI: 0.068–0.428)). The use of orally administered agents was dominant (e.g., more effective and less costly), with average annual cost savings of USD −4336.65 (95% CI: −5207.89–−3903.32) and 8.11% higher rate of effectiveness (95% CI: −14.81–18.07) when compared with Rebif^®. With regard to the use of MABs in comparison to Rebif^®, MABs were associated with higher cost but a better rate of effectiveness, with an average additional annual cost of USD 1381.54 (95% CI: 421.31–3621.06) and 43.11% higher rate of effectiveness (95% CI: 30.38–61.15) when compared with Rebif^®. In addition, the use of MABs was associated with higher cost but a better rate of effectiveness, with an average additional annual cost of USD 5717.88 (95% CI: 4970.75–8272.66) and 35% higher rate of effectiveness (95% CI: 10.0–42.50) when compared with orally administered agents. The use of MABs in the management of RRMS among the young patient population has shown to be the most effective therapy in comparison to both IFN-based therapy (e.g., Rebif^®) and orally administered agents, but with higher cost. Orally administered agents resulted in better outcomes and lower costs in comparison to IFN-based therapy. Future studies should further examine the cost-effectiveness of different disease-modifying therapies for the management of RRMS using more robust study designs. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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8 pages, 928 KiB

Open AccessArticle

The Financial Burden of Surgery for Congenital Malformations—The Austrian Perspective

by Paolo Gasparella, Georg Singer, Bernhard Kienesberger, Christoph Arneitz, Gerhard Fülöp, Christoph Castellani, Holger Till and Johannes Schalamon

Int. J. Environ. Res. Public Health 2021, 18(21), 11166; https://doi.org/10.3390/ijerph182111166 - 24 Oct 2021

Cited by 3 | Viewed by 2311

Abstract

Neonatal “surgical” malformations are associated with higher costs than major “non-surgical” birth defects. We aimed to analyze the financial burden on the Austrian health system of five congenital malformations requiring timely postnatal surgery. The database of the Austrian National Public Health Institute for [...] Read more.

Neonatal “surgical” malformations are associated with higher costs than major “non-surgical” birth defects. We aimed to analyze the financial burden on the Austrian health system of five congenital malformations requiring timely postnatal surgery. The database of the Austrian National Public Health Institute for the period from 2002 to 2014 was reviewed. Diagnosis-related group (DRG) points assigned to hospital admissions containing five congenital malformations coded as principal diagnosis (esophageal atresia, duodenal atresia, congenital diaphragmatic hernia, gastroschisis, and omphalocele) were collected and compared to all hospitalizations for other reasons. Out of 3,518,625 total hospitalizations, there were 1664 admissions of patients with the selected malformations. The annual mean number was 128 (SD 17, range 110–175). The mean cost of the congenital malformations per hospital admission expressed in DRG points was 26,588 (range 0–465,772, SD 40,702) and was significantly higher compared to the other hospitalizations (n = 3,516,961; mean DRG 2194, range 0–834,997; SD 6161; p < 0.05). Surgical conditions requiring timely postnatal surgery place a significant financial burden on the healthcare system. The creation of a dedicated national register could allow for better planning of resource allocation, for improving the outcome of affected children, and for optimizing costs. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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15 pages, 1945 KiB

Open AccessArticle

Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis

by Ayesha Ali, Zina Mobarak, Mariam Al-Jumaily, Mehreen Anwar, Zaeem Moti, Nadia Zaman, Amir Reza Akbari and Laure de Preux

Int. J. Environ. Res. Public Health 2021, 18(16), 8473; https://doi.org/10.3390/ijerph18168473 - 11 Aug 2021

Cited by 5 | Viewed by 4527

Abstract

Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with [...] Read more.

Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. Methods: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. Results: The CUA produced an incremental cost-effectiveness ratio (ICER) of −GBP 23,278.51 (−EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of −GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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Review

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16 pages, 677 KiB

Open AccessReview

Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review

by Taehwan Park, Hyemin Kim, Seunghyun Song and Scott K. Griggs

Int. J. Environ. Res. Public Health 2022, 19(19), 11996; https://doi.org/10.3390/ijerph191911996 - 22 Sep 2022

Cited by 2 | Viewed by 2641

Abstract

There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted [...] Read more.

There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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18 pages, 1787 KiB

Open AccessReview

Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries

by Abdulaziz Ibrahim Alzarea, Yusra Habib Khan, Abdullah Salah Alanazi, Muhammad Hammad Butt, Ziyad Saeed Almalki, Abdullah K. AlAhmari, Saud Alsahali and Tauqeer Hussain Mallhi

Int. J. Environ. Res. Public Health 2022, 19(13), 7862; https://doi.org/10.3390/ijerph19137862 - 27 Jun 2022

Cited by 6 | Viewed by 5467

Abstract

The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with [...] Read more.

The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with the effective use of health resources to optimize the efficiency and costs of medications of treatment for the best outcomes. This review was conducted to find out the potential barriers and facilitators to implementing pharmacoeconomic studies in the Middle Eastern region having both high- and low-income countries. The varying economies in the region depict diverse healthcare systems where implementation of pharmacoeconomics faces a large number of challenges and is also aided by numerous facilitators that contribute to the growth of its implementation. In this context, we have reviewed the status of pharmacoeconomics in Middle Eastern countries in research databases (Google Scholar, MEDLINE, Science Direct and Scopus) using keywords (“pharmacoeconomics”, “barriers”, “facilitators”, “Middle East”). The study reported that Yemen, Syria, Palestine, Iran, Iraq, Jordan and Lebanon are the lowest-income countries in the Middle East and the implementation of pharmacoeconomics is the poorest in these states. The UAE, Saudi Arabia and Israel are high-income rich states where economic aspects were comparatively better but still a large number of barriers hinder the way to its effective implementation. These include the absence of national governing bodies, the lack of data on the effectiveness of medications, the absence of sufficient pharmacoeconomic experts and the lack of awareness of the importance of pharmacoeconomics. The main facilitators were the availability of pharmacoeconomic guidelines, the encouragement of pharmacoeconomic experts and the promotion of group discussions and collaborations between researchers and policymakers. Cost-benefit analysis is still evolving in Middle Eastern countries, and there is a great need for improvement so that states can effectively benefit from cost analysis tools and utilize their health resources. In this regard, governments should develop national governing bodies to evaluate, implement pharmacoeconomics at the local and state levels and bring about innovation in the field through further research and development incorporating all sectors of pharmacy and pharmaceutics. The data presented in this research can further be extended in future studies to cover the various domains of pharmacoeconomics including cost-minimization analysis, cost-effectiveness analysis and cost-benefit analysis and their applications within the healthcare sectors of Middle Eastern countries. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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18 pages, 463 KiB

Open AccessReview

Digital Health Interventions by Clinical Pharmacists: A Systematic Review

by Taehwan Park, Jagannath Muzumdar and Hyemin Kim

Int. J. Environ. Res. Public Health 2022, 19(1), 532; https://doi.org/10.3390/ijerph19010532 - 4 Jan 2022

Cited by 12 | Viewed by 3952

Abstract

Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. The purpose of this study was to systematically review CP-led digital interventions to improve patients’ health-related clinical outcomes. PubMed and the Cochrane Database were searched [...] Read more.

Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. The purpose of this study was to systematically review CP-led digital interventions to improve patients’ health-related clinical outcomes. PubMed and the Cochrane Database were searched to select studies that had conducted a randomized controlled trial to evaluate clinical outcomes in adults following a CP-led digital intervention for the period from January 2005 to August 2021. A total of 19 studies were included in our analysis. In these 19 studies, the most commonly used digital intervention by CPs was telephone use (n = 15), followed by a web-based tool (n = 2) and a mobile app (n = 2). These interventions were provided to serve a wide range of purposes in patients’ outcomes: change in lab values (e.g., blood pressure, HbA1c) (n = 23), reduction in health service use (n = 8), enhancing adherence (n = 6), improvement in drug-related outcomes (n = 6), increase in survival (n = 3), and reduction in health-related risk (e.g., CVD risk) (n = 2). Although the impacts of telephone-based interventions on patients’ outcomes were decidedly mixed, web-based interventions and mobile apps exerted generally positive influences. To date, little research has investigated the cost-effectiveness of digital interventions. Future studies are warranted. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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22 pages, 10135 KiB

Open AccessReview

Advancing African Medicines Agency through Global Health Diplomacy for an Equitable Pan-African Universal Health Coverage: A Scoping Review

by Vijay Kumar Chattu, Vishal B. Dave, K. Srikanth Reddy, Bawa Singh, Biniyam Sahiledengle, Demisu Zenbaba Heyi, Cornelius Nattey, Daniel Atlaw, Kioko Jackson, Ziad El-Khatib and Akram Ali Eltom

Int. J. Environ. Res. Public Health 2021, 18(22), 11758; https://doi.org/10.3390/ijerph182211758 - 9 Nov 2021

Cited by 9 | Viewed by 4760

Abstract

The African continent is home to 15% of the world’s population and suffers from a disease burden of more than 25% globally. In this COVID-19 era, the high burden and mortality are further worsened due to inequities, inequalities such as inadequate health systems, [...] Read more.

The African continent is home to 15% of the world’s population and suffers from a disease burden of more than 25% globally. In this COVID-19 era, the high burden and mortality are further worsened due to inequities, inequalities such as inadequate health systems, scarce financial and human resources, as well as unavailability of inexpensive medicines of good quality, safety, and efficacy. The Universal Health Coverage ensures that people have access to high-quality essential health services, secure, reliable, and affordable essential medicines and vaccines, as well as financial security. This paper aimed at addressing the critical need for a continental African Medicines Agency (AMA) in addressing the inequities and the role of global health diplomacy in building consensus to support the ratification of the Treaty of AMA. A literature review was done in Scopus, Web of Science, MEDLINE/PubMed, and Google Scholar search engine to identify the critical literature in the context of study objectives. All the articles published after 2015 till 2021 in the context of AMA were included. African Health Strategy 2016–2030 highlighted the importance of an African regulatory mechanism for medicines and medical products. Through global health diplomacy (GHD), the African Union and its partners can negotiate and cooperate in providing infrastructural, administrative, and regulatory support for establishing the AMA. The paper emphasizes the South–South cooperation and highlights the contributions of India and China in the supply of medicines and vaccines to Africa. A strong AMA created through GHD can be a vital instrument in utilizing Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities extension and an ideal partner for European and other regional regulatory authorities seeking to stem the tide of counterfeit, sub-standard, or fake products. Full article

(This article belongs to the Special Issue Economic Evaluation of Drugs, Patient Care Intervention(s), and Health Care Program(s))

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