Browsing by Author "Cunnama, Lucy"
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- ItemOpen AccessA comparative cost analysis of the pathway to diagnosing lymphoma in a tertiary hospital, Western Cape, South Africa(2022) Fareed-Brey, Waarisa; Cunnama, Lucy; Verburgh, Estelle; Antel, KatherineCancer is one of the leading causes of death before the age of 70 in 91 countries (out of 172) with a noted increasing incidence of cancer and mortality (Bray et al., 2018). In tuberculosis (TB) endemic areas, a fine needle aspirate (FNA) is often used as the diagnostic tool of choice when trying to understand the underlying cause of lymphadenopathy (LAP), which can lead to delayed diagnosis of lymphoma (Antel et al., 2019). A significant gap exists in the lack of costing of the diagnostic pathway to diagnosing lymphoma. The study aimed to cost the diagnostic pathways, namely FNA, core-needle biopsy (CNB), and surgical excision biopsy (SEB) using secondary data collected in 2018 (February until October) at Groote Schuur Hospital (GSH), within the tertiary level hospital outpatient clinics to informed the patient pathways. The overall purpose of the study was to inform policy-making decisions and process guidelines. A cost analysis study was conducted using a combination of ingredients-based costing and top-down costing from a provider's perspective. Annual costs were calculated and inflated to 2021 South African Rands using the consumer price index (CPI) and converted to United States American Dollars. More CNBs are currently being performed than SEBs at GSH, and when pathways were followed, CNB initiated pathways (US $567) were less costly compared to FNA initiated pathways (US$ 877). The cost of the CNB procedure varied with the use of a single-use biopsy gun and the multi-use Magnum BARD gun. CNB provides an alternate choice to SEB and based on the study conducted, CNB pathways are less costly. The main cost driver for all three procedures was personnel and this could be decreased by task shifting and training of medical officers and interns.
- ItemOpen AccessA mother’s choice: a qualitative study of mothers’ health seeking behaviour for their children with acute diarrhoea(BioMed Central, 2016-11-21) Cunnama, Lucy; Honda, AyakoBackground: Diarrhoea presents a considerable health risk to young children and is one of the leading causes of infant mortality. Although proven cost-effective interventions exist, South Africa is yet to reach the Sustainable Development Goals set for the elimination of preventable under-five mortality and water-borne diseases. The rural study area in the Eastern Cape of South Africa continues to have a parallel health system comprising traditional and modern healthcare services. It is in this setting that this study aimed to qualitatively examine the beliefs surrounding and perceived quality of healthcare accessed for children’s acute diarrhoea. Methods: Purposive sampling was used to select participants for nine focus-group-discussions with mothers of children less than 5 years old and 11 key-informant-interviews with community members and traditional and modern practitioners. The focus-group-discussions and interviews were held to explore the reasons why mothers seek certain types of healthcare for children with diarrhoea. Data was analysed using manual thematic coding methods. Results: It was found that seeking healthcare from traditional practitioners is deeply ingrained in the culture of the society. People’s beliefs about the causative agents of diarrhoea are at the heart of seeking care from traditional practitioners, often in order to treat supposed supernatural causes. A combination of care-types is acceptable to the community, but not necessarily to modern practitioners, who are concerned about the inclusion of unknown ingredients and harmful substances in some traditional medicines, which could be toxic to children. These factors highlight the complexity of regulating traditional medicine. Conclusion: South African traditional practitioners can be seen as a valuable human resource, especially as they are culturally accepted in their communities. However due to the variability of practices amongst traditional practitioners and some reluctance on the part of modern practitioners regulation and integration may prove complex.
- ItemOpen AccessA Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach(2021) Soboil, Joshua; Cunnama, Lucy; Wilkinson, TommyWhen constructing a health economic decision model, it is critical to select a sensitivity analysis approach appropriate for the decision context. This point is particularly salient to Middle-Income Countries (MICs), where there is relatively heightened resource scarcity and increased opportunity-cost. MICs face acute shortages of accessible as well as highquality evidence, resulting in a frequent imputing of data from external jurisdictions. Conversely, there are also shortages in skills and research capacity, creating a strong complementary need to consider the contextual feasibility of applying more resource demanding sensitivity analysis methodologies. Given the above, it is therefore critical to establish whether and when the technical benefits of complex and resource demanding methods result in real-world value. We apply a comparative case study using a comprehensive approach to decision-modelling, implemented in the R and JAGS languages. Specifically, the case study replicates a deterministic model originally used to inform the cost-effectiveness of adding a bivalent Human Papilloma Virus (HPV) vaccine to South Africa's public health care cervical cancer screening programme. Crucially, the case study provides critical insight into the pros and cons of implementing more complex sensitivity analysis techniques within MIC climates. Our findings indicate that the benefits of more advanced sensitivity analysis methods are nuanced; are therefore contextually beneficial according to a case-by-case basis; and, moreover, choosing a sensitivity analysis method should be guided by a conceptual ‘fruitfulness' (i.e. a bang-for-buck), more than a mere desire to reduce model complexity. To aid analysts in this process, from our comparative case study we provide a framework with three core concept areas namely Decision-Maker Preferences (Decision Power, Investment, Risk Aversion), Analytical Considerations (Available resources, Indirect Evidence) and Policy Context (Knowledge of Topic, Technical Expertise). The framework intends to encourage more judicious selection of sensitivity analysis methods; help reduce the methodological variation apparent in MIC settings; and simultaneously provide decision-makers with greater methodological transparency in the selection of sensitivity analysis methods.
- ItemOpen AccessSystematic review of economic evaluations for paediatric pulmonary diseases(2021) Chitando, Mutsawashe; Cunnama, LucyBackground Pulmonary diseases are the leading causes of mortality globally amongst children under five years of age. Economic evaluations (EEs) guide decision-makers on which health care intervention to adopt to reduce paediatric pulmonary disease burden. Methods We systematically reviewed EEs for paediatric pulmonary diseases published globally between 2010 and 2020. We searched PubMed, Web of Science, MEDLINE, Paediatric Economic Database Evaluation (PEDE), and the Cochrane library. EEs included were specific to paediatric pulmonary diseases in a hospital setting and of children aged from zero to six years old. We extracted data items guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. We collected qualitative and quantitative data which we analysed in Microsoft Excel and R Software. Results 22 studies met the inclusion criteria. Seven of the articles were cost-effectiveness analyses, five cost-utility analyses, two cost-minimisation analyses, and eight cost analyses. Fourteen studies were conducted in high-income countries, eight in low-middle-income countries (LMICs). Ten studies were on asthma, nine on pneumonia, two on asthma and pneumonia, and one on tuberculosis. Quality assessment of the articles revealed some methodological inconsistencies across the articles. Conclusion Fewer EEs were conducted in LMICs, yet children from these countries are disproportionately affected by pulmonary diseases. Developing standardised methods for EEs and conducting more EEs and for paediatric pulmonary diseases in LMICs could allow for more evidence-based decision-making.
- ItemOpen AccessThe cost of providing consultative palliative care services in a tertiary hospital setting(2020) Mbuthini, Linda; Cunnama, Lucy; Krause, René; Moodley, JenniferBackground The Sub-Saharan African region has sparse palliative care established to cater for patients facing life limiting conditions. In South Africa, costing frameworks for palliative care interventions for the public sector do not exist and the cost of running a comprehensive palliative care programme remains unknown. There are few costing studies to inform costs of palliative care models which are necessary for decision makers to base their decisions on. The aim of this study was to determine the costs and cost drivers for hospital based consultative palliative care service (HBPCS) in South Africa adopting a providers' perspective. Methods In this empirical costing study, we developed and utilised a costing tool that employed a mixed bottom-up and top-down costing method to estimate the incremental cost of an existing hospital based consultative palliative care services (HBCPCS) in a tertiary hospital in Cape Town, South Africa, called Groote Schuur Hospital (GSH) adopting a public provider perspective. All inputs where valued using bottom-up, ingredients-based methods, except for direct staff where a top-down approach was utilised to allocate the staff's full salary to palliative care services. We collected costing data by conducting inventory audits, key informant interviews and observations. All inputs required in the production of the HBCPCS were checked against a costing framework for economic evaluations of palliative care interventions to ensure that the cost estimates were as inclusive as possible. All inputs with a lifespan of more than one year were annuitized using a 3% rate. Results The total annual cost for running the HBCPCS was R2 494 419 including both recurrent and capital costs. Recurrent items alone accounted for 96% (R2 392 407). While capital items accounted for 4% (R102 013) during the study period. The total cost per visit was R642 including the standard drug treatment package (R16). The major cost driver in the service was personnel accounting or 91% of the total annual cost. While a scenario analysis shows that when the size of the team size is doubled then the cost of direct personnel would increase to R4.4 million. Conclusion We have estimated the incremental unit cost of HBCPCS to be R642 per visit, the major cost driver being personnel. If funding allows, with an annual cost of R2.4 million these services can be provided in a public tertiary hospital as an adjunct to inpatient care for patients as a strategy for integrating palliative care to general health care services, as has been done at GSH. The HBCPCS was less costly when compared to hospital-based outreach palliative care programmes.