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Evaluating the medical direct costs associated with prematurity during the initial hospitalization in Rwanda: a
Anaclet Ngabonzima1, Domina Asingizwe2, David Cechetto3
1JSI Research & Training Institute, Inc, Washington, DC, USA. ngabanac2@gmail.com.
Insights
The average cost of hospitalization for premature babies (PBs) in Rwanda was $237.7, significantly impacting the health budget. Key cost drivers included drugs, supplies, and oxygen therapy, highlighting areas for intervention.
Area of Science:
- Neonatal Medicine
- Health Economics
- Public Health Policy
Background:
- Prematurity is a leading cause of neonatal mortality globally and in Rwanda.
- High hospitalization costs for premature babies strain Rwanda's health budget.
- Understanding these costs is crucial for effective health planning.
Purpose of the Study:
- To determine the direct medical costs (MDC) associated with the initial hospitalization of premature babies in Rwanda.
- To identify factors influencing these hospitalization costs.
Main Methods:
- Prospective cost of illness study using a prevalence approach.
- Inclusion of 123 premature babies across 5 Rwandan hospitals.
- Analysis of medical direct costs, including drugs, supplies, and oxygen therapy.
Main Results:
- Overall mean MDC was $237.7 per premature baby, representing 28% of Rwanda's GDP per capita.
- Drugs and supplies constituted 65% of MDC, with oxygen therapy being a major driver.
- Birth weight, oxygen therapy, and hospital level significantly predicted MDC.
Conclusions:
- The study provides critical data on the medical direct costs of premature infant hospitalization in Rwanda.
- Identified predictive factors like birth weight can inform prematurity prevention strategies.
- Recommendations include revising health insurance benefits and investing in oxygen infrastructure.
Background:
Prematurity is still the leading cause of global neonatal mortality, Rwanda included, even though advanced medical technology has improved survival. Initial hospitalization of premature babies (PBs) is associated with high costs which have an impact on Rwanda's health budget. In Rwanda, these costs are not known, while knowing them would allow better planning, hence the purpose and motivation for this research.
Methods:
This was a prospective cost of illness study using a prevalence approach conducted in 5 hospitals (University Teaching Hospital of Butare, Gisenyi, Masaka, Muhima, and Ruhengeri). It included PBs admitted from June to July 2021 followed up prospectively to determine the medical direct costs (MDC) by enumerating the cost of all inputs. Descriptive analyses and ordinary least squares regression were used to illustrate factors associated with and predictive of mean cost. The significance level was set at p < 0.05.
Results:
A total of 123 PBs were included. Very preterm and moderate PBs were 36.6% and 23.6% respectively and the average birth weight (BW) was 1724 g (SD: 408.1 g). The overall mean MDC was $237.7 per PB (SD: $294.9) representing 28% of Gross Domestic Product (GDP) per capita per year. Costs per PB varied with weight category, prematurity degree, hospital level, and length of stay (LoS) among other variables. MDC was dominated by drugs and supplies (65%) with oxygen being an influential driver of MDC accounting for 38.4% of total MDC. Birth weight, oxygen therapy, and hospital level were significant MDC predictive factors.
Conclusion:
This study provides an in-depth understanding of MDC of initial hospitalization of PBs in Rwanda. It also indicates predictive factors, including birth weight, which can be managed through measures to prevent or delay preterm birth.
Implication For Prematurity Prevention And Management:
The results suggest a need to revise the benefits and entitlements of insured people to include drugs and interventions not covered that are essential and where there are no alternatives. Having oxygen plants in hospitals may reduce oxygen-related costs. Furthermore, interventions to reduce prematurity should be evaluated using cost-effectiveness analysis since its overall burden is high.
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