Factors associated with odds of CHEs for VPDs.

BackgroundVaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia.Methods and findingsWe conducted a cross-sectional costing analysis, from the household (patient) perspective, of care-seeking for VPDs in children aged under 5 years for pneumonia, diarrhea, measles, and pertussis, and in children aged under 15 years for meningitis. Data on OOP direct medical and nonmedical expenditures (2021 USD) and household consumption expenditures were collected from 995 households (1 child per household) in 54 health facilities nationwide between May 1 and July 31, 2021. We used descriptive statistics to measure the main outcomes: magnitude of OOP expenditures, along with the associated CHE within households. Drivers of CHE were assessed using a logistic regression model. The mean OOP expenditures per disease episode for outpatient care for diarrhea, pneumonia, pertussis, and measles were $5·6 (95% confidence interval (CI): $4·3, 6·8), $7·8 ($5·3, 10·3), $9·0 ($6·4, 11·6), and $7·4 ($3·0, 11·9), respectively. The mean OOP expenditures were higher for inpatient care, ranging from $40·6 (95% CI: $12·9, 68·3) for severe measles to $101·7 ($88·5, 114·8) for meningitis. Direct medical expenditures, particularly drug and supply expenses, were the major cost drivers. Among those who sought inpatient care (345 households), about 13·3% suffered CHE, at a 10% threshold of annual consumption expenditures. The type of facility visited, receiving inpatient care, and wealth were significant predictors of CHE (p-value ConclusionsThe OOP expenditures induced by VPDs are substantial in Ethiopia and disproportionately impact those with low income and those requiring inpatient care. Expanding equitable access to vaccines cannot be overemphasized, for both health and economic reasons. Such realization requires the government’s commitment toward increasing and sustaining vaccine financing in Ethiopia.背景：疫苗可预防疾病（Vaccine-preventable diseases, VPDs）仍是低收入和中等收入国家（low- and middle-income countries, LMICs）发病与死亡的主要诱因。实现疫苗的全民可及性，除可改善健康结局外，还能大幅降低与VPDs相关的自费（out-of-pocket, OOP）支出及关联财务风险。本研究旨在估算埃塞俄比亚部分VPDs对应的自费支出规模，以及由此引发的灾难性卫生支出（catastrophic health expenditures, CHEs）水平。 方法与结果：本研究以家庭（患者）为视角开展横断面成本分析，针对埃塞俄比亚5岁以下儿童的肺炎、腹泻、麻疹、百日咳，以及15岁以下儿童的脑膜炎这几类VPDs的就医行为进行成本核算。研究于2021年5月1日至7月31日期间，在全国54家医疗机构收集了995户家庭（每户纳入1名患儿）的自费直接医疗与非医疗支出（以2021年美元计价）及家庭消费支出数据。本研究采用描述性统计方法测算主要结局指标：自费支出规模，以及家庭中发生的灾难性卫生支出情况；通过logistic回归模型分析灾难性卫生支出的影响因素。结果显示，腹泻、肺炎、百日咳、麻疹门诊治疗的单次疾病发作平均自费支出分别为5.6美元（95%置信区间（confidence interval, CI）：4.3~6.8美元）、7.8美元（5.3~10.3美元）、9.0美元（6.4~11.6美元）和7.4美元（3.0~11.9美元）。住院治疗的平均自费支出更高，区间为重症麻疹的40.6美元（95%CI：12.9~68.3美元）至脑膜炎的101.7美元（88.5~114.8美元）。直接医疗支出，尤其是药品与耗材费用，是主要的成本驱动因素。在345户选择住院治疗的家庭中，以年度消费支出的10%作为阈值，约13.3%的家庭发生了灾难性卫生支出。就诊医疗机构类型、是否接受住院治疗以及家庭财富水平均为灾难性卫生支出的显著预测因子（p值<0.001）。 结论：埃塞俄比亚由VPDs引发的自费支出规模可观，且对低收入群体与需住院治疗的人群造成不成比例的冲击。无论从健康还是经济层面考量，推进疫苗的公平可及性至关重要，这一点无论如何强调都不为过。而要实现这一目标，需要埃塞俄比亚政府承诺加大并持续保障疫苗相关融资投入。