Cost-of-illness of cholera to households and health facilities in rural Malawi

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients’ households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

霍乱仍是众多中低收入国家面临的重要公共卫生问题。疫苗接种已被推荐为霍乱防控的可行干预手段。但目前支撑疫苗扩大使用的相关证据仍较为薄弱，尤其是在疾病负担、疾病成本、接种成本与成本效益方面的数据尚且不足。本研究旨在估算马拉维马钦加（Machinga）与宗巴（Zomba）地区的家庭及医疗卫生机构的霍乱疾病成本。本研究采用回顾性收集的成本数据开展横断面研究。研究采用目的性抽样法选取100例患者，用于家庭层面的霍乱疾病成本评估；同时选取4家霍乱治疗中心与1家医疗卫生机构，开展医疗卫生机构层面的成本评估。家庭层面评估收集的数据涵盖霍乱患者及其家庭承担的直接与间接成本，而医疗卫生机构层面的评估仅考量直接成本。研究尽可能采用描述性分析与回归分析，以比较不同患者组的平均成本差异。2016年，每例霍乱病例的家庭治疗平均成本为65.6美元，医疗卫生机构的平均治疗成本为59.7美元；按同年国际元（international dollars, I$）折算，分别为249.9与227.5。霍乱病例的治疗成本与住院时长呈正相关关系。此外，52%的家庭采取了应对策略，以弥补疾病带来的直接与间接成本负担。若扩大抢先式霍乱疫苗接种的使用范围，家庭与医疗卫生机构均可大幅节省治疗支出。本研究结果可为霍乱防控领域的优先投资决策提供直接政策参考依据。