Andre Bovell

Cost analysis of hospital-based symptomatic uterine fibroids in the kingdom of Eswatini: A prevalence-based cost-of-illness study

Background Uterine fibroids are common benign tumours of uterine smooth muscle. It has been established that uterine fibroids cause a marked global financial burden on healthcare systems and society; however, significant gaps exist in the knowledge of costs related to uterine fibroids. This study aimed to estimate costs associated with the diagnosis, care, and management of uterine fibroids in Eswatini. Methods The study employed the Cost of Illness (COI) method, a retrospective prevalence cost model. The provider’s perspective was used to estimate all identifiable direct medical costs of UFs. Data was collected from participants’ charge and claims records from the hospitals between 21 August 2021 and 21 August 2022. The study employed a bottom-up approach to estimate all patient costs related to uterine fibroids care and treatment. The costs were calculated at the 2022 price level and converted to United States dollars (USD) using private-payer prices. Results The total annual direct medical cost of uterine fibroids in Eswatini was estimated at USD 837894.60. This includes the total estimated costs of outpatient treatment and care, surgical treatment and care, and inpatient treatment and care. The key cost drivers were surgical and inpatient costs, USD 421583.18 and USD 110716.59, respectively. Conclusion The total annual cost estimation of uterine fibroids care is significantly high, with the majority of the cost related to theatre and hospitalisation charges. Understanding these financial implications can help guide healthcare policies and resource management.

Investigating Drug Treatment Costs and Patient Characteristics of Female Breast, Cervical, Colorectal, and Prostate Cancers in Antigua and Barbuda: A Retrospective Data Study (2017–2021)

Cancers are problematic for health systems globally, including in Antigua and Barbuda, where understanding the changing extent of common cancers is key to implementing effective prevention and control strategies. This study aimed to assess the relationship between treatment rates and drug treatment costs along with characteristics affecting these costs for patients with female breast, cervical, colorectal and prostate cancers in Antigua and Barbuda from 2017 to 2021. A retrospective observational study design was used. Estimates of age-standardized treatment rates and drug treatment costs were determined using direct standardization and a micro-costing approach, respectively. Linear regression was used to evaluate the relationship between age-standardized treatment rates and drug treatment costs. Model independent variables were assessed for multicollinearity and residuals examined for variance and normality. With a sum of 242 cases identified for this study, each cancer type showed evidence of strong positive correlations and significant associations between treatment costs and age-standardized treatment rates. The mean cost (USD) of drug treatment was highest for female breast (USD 25,009.63) and colorectal (USD 13,317.16) cancers and lowest for prostate (USD 12,528.10) and cervical (USD 5121.41) cancers, with several variables showing significance in the respective final models. An association existed between age-standardized treatment rates and drug treatment costs for the cancers studied. These results offer a basis for encouraging strategies in obtaining affordably priced cancer medicines in Antigua and Barbuda.

Overall Observed Survival of Female Breast, Cervical, Colorectal, and Prostate Cancers in Antigua and Barbuda, 2017–2021: Retrospective Data from Four Study Sites

Understanding cancer survival is important for countries such as Antigua and Barbuda, where female breast, cervical, colorectal, and prostate cancers are burdensome to the healthcare system. This study therefore aimed to estimate the survival probabilities of patients diagnosed with these cancers between 2017 and 2021. A retrospective analytical study design was used to evaluate cancer cases abstracted from medical records at key study sites. Estimates of observed survival probabilities were determined using a Kaplan–Meier analysis. Significant differences between survival curves were assessed using the log-rank test. Hazard ratios were calculated using Cox regression. A p-value < 0.05 indicated significance. A total of 391 diagnosed cases were included in this study (2017–2021): female breast cancer accounted for 42%, cervical cancer accounted for 10%, colorectal cancer accounted for 20%, and prostate cancer accounted for 28%. Overall, the mean age of the participants was 61.5 (±12.9) years; 62% were female, 73% were aged > 55 years, 56% were from St. John’s, and 82% were alive at the end of 2021. The median overall survival (years) was 4.8 for female breast cancer, 4.1 for cervical cancer, 4.5 for colorectal cancer, and not reached for prostate cancer. The cancer-specific overall observed 5-year survival probabilities were 44.9% for female breast cancer, 10.8% for cervical cancer, 19.6% for colorectal cancer, and 69.0% for prostate cancer. Significant associations between disease stage and overall survival were observed in female breast and colorectal cancers. This study provides important evidence for the 5-year observed survival probabilities of the studied cancers. Healthcare improvements that support cancer survival are required.

Cost Analysis Related to Diagnosis, Treatment and Management of Cervical Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Study

Cervical cancer remains a significant public health issue globally. In Antigua and Barbuda, cervical cancer is ranked among the top five most common cancers in terms of incidence and mortality among females. There is no evidence that the costs of diagnosing, treating, and managing this cancer have been studied before in Antigua and Barbuda. From the providers’ perspective, this study aimed to estimate costs associated with cervical cancer in Antigua and Barbuda. The prevalence-based cost-of-illness methodology was used to assess patient data abstracted from four study sites for the period 2017–2021, and to derive the annual prevalence. Top-down and bottom-up costing approaches were used to estimate direct medical costs. Costs were computed using the 2021 price level and converted to United States Dollars (USD). Total annual direct medical costs of cervical cancer were estimated at USD 0.24 million (ranging between USD 0.19 million and USD 0.30 million). Major cost drivers were treatment (USD 112,863.76), post-treatment side-effects care (USD 67,406.57), and the diagnostic process (USD 26,238.58). The overall direct medical unit costs for managing a case were estimated at USD 115,822.09. Our study reflects the current estimates for managing cervical cancer and provides evidence to complement cervical cancer prevention and cost containment measures in Antigua and Barbuda.