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SOCIETAL PERSPECTIVE ON COST DRIVERS FOR HEALTH TECHNOLOGY ASSESSMENT IN SINDH, PAKISTAN.

TitleSOCIETAL PERSPECTIVE ON COST DRIVERS FOR HEALTH TECHNOLOGY ASSESSMENT IN SINDH, PAKISTAN.
Publication TypeJournal Article
Year of Publication2017
AuthorsKhowaja, A, Mitton, C, Qureshi, R, Bryan, S, Magee, LA, von Dadelszen, P, Bhutta, ZA
JournalInt J Technol Assess Health Care
Volume33
Issue2
Pagination192-198
Date Published2017 Jan
ISSN1471-6348
KeywordsCLIP, Female, Health Facilities, Humans, Male, Pakistan, Patient Acceptance of Health Care, Pre-Eclampsia, Pregnancy, Qualitative Research, Technology Assessment, Biomedical
Abstract

BACKGROUND: Understanding cost-drivers and estimating societal costs are important challenges for economic evaluation of health technologies in low- and middle-income countries (LMICs). This study assessed community experiences of health resource usage and perceived cost-drivers from a societal perspective to inform the design of an economic model for the Community Level Interventions for Pre-eclampsia (CLIP) trials.

METHODS: Qualitative research was undertaken alongside the CLIP trial in two districts of Sindh province, Pakistan. Nine focus groups were conducted with a wide range of stakeholders, including pregnant women, mothers-in-law, husbands, fathers-in-law, healthcare providers at community and health facility-levels, and health decision/policy makers at district-level. The societal perspective included out-of-pocket (OOP), health system, and program implementation costs related to CLIP. Thematic analysis was performed using NVivo software.

RESULTS: Most pregnant women and male decision makers reported a large burden of OOP costs for in- and out-patient care, informal care from traditional healers, self-medication, childbirth, newborn care, transport to health facility, and missed wages by caretakers. Many healthcare providers identified health system costs associated with human resources for hypertension risk assessment, transport, and communication about patient referrals. Health decision/policy makers recognized program implementation costs (such as the mobile health infrastructure, staff training, and monitoring/supervision) as major investments for the health system.

CONCLUSIONS: Our investigation of care-seeking practices revealed financial implications for families of pregnant women, and program implementation costs for the health system. The societal perspective provided comprehensive knowledge of cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.

DOI10.1017/S0266462317000320
Alternate JournalInt J Technol Assess Health Care
Citation Key543
PubMed ID28587686
PubMed Central IDPMC5934709