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Prevention and treatment of cardiovascular disease in Ethiopia saves more than lives: cost-effectiveness analysis, extended cost-effectiveness analysis, and financial risk protection
Get PDFIntroduction: The burden from cardiovascular disease (CVD) and its risk factors is growing in Ethiopia, especially in urban areas. Yet, the coverage of effective strategies towards its successful control is low. In the absence of universal coverage, affected households are forced to cover the cost of needed health care through direct out-of-pocket (OOP) payments upon use of services. OOP payments could be prohibitive to health care access and often entail trading-off other essential consumptions, especially among the poor. Therefore, protecting households from such unprecedented financial consequences is one of the key health systems objectives. Nevertheless, Ethiopia is faced with extreme resource scarcity. Therefore, priorities need to be carefully evaluated and systematically identified among competing alternatives. This thesis aims to generate policy-relevant evidence on health outcomes, costs, and financial risk protection of CVD interventions so as to inform priority setting decisions in Ethiopia. Methods: To meet these aims, we conducted three studies using distinct methods. First, to assess the financial risk related to seeking CVD care, we conducted a crosssectional cohort study among individuals who sought prevention and treatment services for CVD in selected hospitals in Addis Ababa, Ethiopia. In study II, a costeffectiveness analysis (CEA) of a broad range of prevention and treatment services for CVD was performed in an Ethiopian setting so as to identify cost-effective alternatives for a potential scale-up in Ethiopia. In study III, extended costeffectiveness analysis was used to estimate the distribution (across income quintiles) of health benefits (disability-adjusted life years (DALYs) averted) and financial risk protection (cases of catastrophic health expenditure averted (CHE)) from universal public finance (UPF) of primary prevention of CVD with a multidrug therapy (aspirin, antihypertensives, and statins) for individuals with increased absolute risk of CVD. CHE is here defined as annual OOP expenditure on CVD care 10% or more of households’ annual income. Results: Overall, 27% [95% CI (23.1, 30.6)] of the households faced CHE. About 28% among the poorest quintile, in contrast to 14% among the richest quintile faced CHE. This financial risk affected mainly the poor, those who have had stroke, those who have been hospitalized, and those who travelled to Addis Ababa from outside the city to seek CVD care. Moreover, the households that faced CHE among the poorest quintile spent 34% of their annual income on CVD care per year compared with a 15% average among the richest quintile. This shows that the poorest households suffered a more severe intensity of financial risk among than the richest quintile. We found that primary prevention of CVD with the multidrug therapy is costeffective in an Ethiopian setting with an estimated cost of USD 67 per DALY averted at > 35% absolute risk of developing a CVD event over the next 10 years. The incremental cost per an additional DALY averted increased moderately at lower risk levels and reached USD 340 per DALY averted at > 5% risk level. A package of aspirin, ACE-inhibitor, beta-blocker, and streptokinase for acute myocardial infarction (with an estimated cost of USD 1,000 per DALY averted); a package of aspirin, ACE-inhibitor, beta-blocker, and statin for secondary prevention of ischemic heart disease (with an estimated cost of USD 1,850 per DALY averted); and a package of aspirin, ACE-inhibitor and statin for secondary prevention of stroke (with an estimated cost of USD 1,060 per DALY averted), although they dominated the comparators within their respective clusters, they were deemed less cost-effective than primary prevention. Furthermore, we estimated that substantial health and financial risk protection gains can be expected from UPF of the multidrug therapy for primary prevention of CVD. In total, the policy averted about 5,800 DALYs and 850 cases of CHE per year at an estimated annual cost of USD 1.9 million. Disaggregated by risk level, the DALYs averted ranged from 1,180 (at > 25%) to 2,240 (at > 15%), whereas the cases of CHE averted ranged from 96 (at > 35%) to 394 (at > 5%). The DALYs averted were distributed across income quintiles (Q1—the poorest to Q5—the richest) as: 22% (Q1), 18% (Q2), 24% (Q3), 26% (Q4), and 10% (Q5); while CHE averted were distributed as: 23% (Q1), 20% (Q2), 21% (Q3), 23% (Q4), and 13% (Q5). These distributional patterns were maintained at all CVD risk levels. Conclusions: Seeking prevention and treatment of CVD represents a significant financial risk to households, with a disproportionate impact on the poorest, those who have had stroke, and those who reside outside Addis Ababa. Primary prevention of CVD with multidrug therapy to individuals with increased absolute risk of CVD is a cost-effective strategy that Ethiopia could consider for successful control of CVD. Public finance of this intervention would generate a sizeable financial risk protection gains in addition to the health benefits. Both the health gain and financial risk protection gains favor the poorer households—qualifying the strategy as a pro-poor with respect to both outcomes. Primary prevention of cardiovascular disease saves more than lives in Ethiopia
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey
Get PDFObjectives HIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.
Design A cross-sectional survey.
Setting 27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.
Participants A total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.
Outcome measures The economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.
Results The mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was 170) per year and 118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was 66) per year for HIV and 83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).
Conclusions HIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.publishedVersio
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Financial risk of road traffic trauma care in public and private hospitals in Addis Ababa, Ethiopia: A cross-sectional observational study
Get PDFBackground
Road traffic injuries are among the most important causes of morbidity and mortality and cause substantial economic loss to households in Ethiopia. This study estimates the financial risks of seeking trauma care due to road traffic injuries in Addis Ababa, Ethiopia.
Methods
This is a cross-sectional survey on out-of-pocket (OOP) expenditures related to trauma care in three public and one private hospital in Addis Ababa from December 2018 to February 2019. Direct medical and non-medical costs (2018 USD) were collected from 452 trauma cases. Catastrophic health expenditures were defined as OOP health expenditures of 10% or more of total household expenditures. Additionally, we investigated the impoverishment effect of OOP expenditures using the international poverty line of 256 for outpatient visits and 96 and $68 per patient, respectively.
Conclusion
Seeking trauma care after a road traffic injury poses a substantial financial threat to Ethiopian households due to lack of strong financial risk protection mechanisms. Ethiopia's government should enact multisectoral interventions for increasing the prevention of road traffic injuries and implement universal public finance of trauma care
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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