Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis.

Autor:	Nambaziira R; University of Global Health Equity, Butaro, Rwanda., Niteka LC; University of Global Health Equity, Butaro, Rwanda., Dusengimana JMV; Partners In Health, Butaro, Rwanda., Ruhumuriza J; Partners In Health, Butaro, Rwanda., Bhangdia KP; Harvard T H Chan School of Public Health, Boston, Massachusetts, USA., Mugunga JC; Monitoring, Evaluation and Quality Improvement, Partners In Health, Arlington, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Uwineza ML; Rwanda Ministry of Health, Butaro, Rwanda., Rugema V; Rwanda Ministry of Health, Butaro, Rwanda., Erfani P; Harvard Medical School, Boston, Massachusetts, USA., Shyirambere C; Partners In Health, Butaro, Rwanda., Shulman LN; University of Pennsylvania, Philadelphia, Pennsylvania, USA., Rabideau M; University of Global Health Equity, Butaro, Rwanda., Pace LE; Brigham and Women's Hospital, Boston, Massachusetts, USA lpace@bwh.harvard.edu.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Jun 30; Vol. 12 (6), pp. e062357. Date of Electronic Publication: 2022 Jun 30.
DOI:	10.1136/bmjopen-2022-062357
Abstrakt:	Objectives: This study aimed to quantify the health system cost of the first 2 years of a Breast Cancer Early Detection (BCED) programme in a rural district in Rwanda. We also aimed to estimate the cost of implementing the programme in other districts with different referral pathways and identify opportunities for enhanced cost efficiency. Design: Retrospective, cross-sectional analysis using time-driven activity-based costing, based on timed patient clinical encounters, retrospective patient data and unit costs of resources abstracted from administrative and finance records. Setting: The BCED programme focused on timely evaluation of individuals with breast symptoms. The study evaluated the health system cost of the BCED programme at seven health centres (HCs) in Burera district and Butaro Cancer Centre of Excellence (BCCOE) at Butaro District Hospital. Outcome Measures: Health system costs per patient visit and cost per cancer diagnosed were quantified. Total start-up and recurring operational costs were also estimated, as well as health system costs of different scale-up adaptations in other districts. Results: One-time start-up costswere US$36 917, recurring operational costswere US$67 711 and clinical costswere US$14 824 over 2 years. Clinical breast examinations (CBE) at HCs cost US$3.27/visit. At BCCOE, CBE-only visits cost US$13.47/visit, CBE/ultrasound US$14.79/visit and CBE/ultrasound/biopsy/pathology US$147.81/visit. Overall, clinical cost per breast cancer diagnosed was US$1482. Clinicalcost drivers were personnel at HCs (55%) and biopsy/pathology supplies at BCCOE (46%). In other districts, patients experience a longer breast evaluation pathway, adding about US$14.00/patient; this could be decreased if ultrasound services were decentralised. Conclusion: Clinical costs associated with BCED services at HCs were modest, similar to other general outpatient services. The BCED programme's start-up and operational costs were high but could be reduced by using local trainers and virtual mentorship. In other districts, decentralising ultrasound and/or biopsies to district hospitals could reduce costs. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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