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Objective To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. Methods The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted. Findings The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, Cl: 61.7-65.2) in the quinine arm and US$ 66.5 (95% Cl: 63.7-69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively. Conclusion Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible. Objectif Etudier la rentabilite de l'artesunate parenteral dans le cadre du traitement d'enfants gravement atteints de paludisme et son impact potentiel sur les budgets hospitaliers. Methodes Les couts des soins administres aux patients hospitalises gravement atteints de paludisme ont ete evalues dans 4 des 11 sites participant a l'essai Traitement quinine/artesunate contre le paludisme en Afrique, realise sur plus de 5400 enfants. Afin de calculer le cout de l'hospitalisation, les medicaments, les essais en laboratoire et les liquides intraveineux administres a 2300 patients entre leur admission et leur sortie ont ete enregistres, ainsi que la duree de l'hospitalisation. Les donnees ont ete comparees avec les resultats cliniques regroupes et integres a un modele de decision afin de calculer le cout par annee de vie corrigee du facteur invalidite (AVCI) evite et le cout par deces evite. Resultats Le cout moyen du traitement des patients gravement atteints du paludisme s'est revele similaire dans les deux groupes experimentaux: 63,5 dollars americains (US$) (intervalle de confiance 95% IC: 61,7-65,2) pour le bras recevant la quinine et 66,5 US$ (95% IC: 63,7-69,2) pour le bras recevant l'artesunate. Les enfants traites par artesunate affichaient un taux de mortalite inferieur de 22,5% a ceux recevant de la quinine, et un taux de sequelles neurologiques identique: (bras recevant l'artesunate: 2,3 AVCI par patient; bras recevant la quinine: 3,0 AVCI par patient). En comparaison avec la quinine en tant que ligne de base, l'artesunate a demontre un cout incremental par AVCI evitee et un cout incremental par deces evite de 3,8 US$ et 123 US$, respectivement. Conclusion Dans le cadre du traitement des enfants gravement atteints de paludisme, rartesunate constitue une alternative extremement rentable et abordable par rapport a la quinine. Les implications budgetaires liees a l'adoption de l'artesunate pour une utilisation habituelle Iors des soins hospitaliers sont negligeables. Objetivo Analizar la relacion coste-eficacia del artesunato parenteral en el tratamiento de la malaria grave infantil y su posible impacto en los presupuestos hospitalarios. Metodos En cuatro de los 11 centros incluidos en el Estudio comparativo de los tratamientos de la malaria con artesunato y quinina en Africa participaron mas de 5400 ninos. Para calcular el coste de la hospitalizacion se registraron los farmacos, las pruebas clinicas y los liquidos endovenosos suministrados a 2300 pacientes, desde su ingreso hasta el alta, segun la duracion del ingreso del paciente. Los datos se compararon con los resultados clinicos agrupados e introducidos en un modelo de decision para calcular el coste por ano de vida ajustada por discapacidad (AVAD) evitada y el coste por muerte evitada. Resultados El coste medio del tratamiento de los pacientes con malaria grave fue similar en los dos grupos del estudio: 63,5 dolares estadounidenses (US$) (intervalo de confianza del 95%, IC: 61,7-65,2) en el grupo de quinina y US$ 66,5 (IC del 95%: 63,7-69,2) en el grupo de artesunato. Los ninos tratados con artesunato presentaron una mortalidad un 22,5% inferior que los tratados con quinina y la misma tasa de secuelas neurologicas: (grupo de artesunato: 2,3 AVAD por paciente; grupo de quinina: 3,0 AVAD por paciente). En comparacion con la quinina como referencia, el artesunato ha mostrado un coste incremental por AVAD evitado y un coste incremental por muerte evitada de US$ 3,8 y US$ 123, respectivamente. Conclusion El artesunato es una alternativa a la quinina muy rentable y con una excelente relacion coste-eficacia para el tratamiento de ninos con malaria grave. Las implicaciones presupuestarias de la adopcion del artesunato para su uso sistematico en la asistencia hospitalaria son insignificantes., Introduction Despite reported falling transmission in much of sub-Saharan Africa, (1-3) malaria remains a leading cause of inpatient admissions and mortality in paediatric wards. (4-6) The policy for first-line treatment [...]

This cross-sectional study examined factors affecting Health-related Quality of Life (HRQoL) among 273 HIV-infected key populations. This included, men who have sex with men (MSM), people, who inject drugs (PWID), and sex workers (SW), who were currently receiving antiretroviral therapy (ART) in Myanmar. Participants were recruited from four non-government clinics in four main cities. Overall HRQoL score derived from the WHOQOL-HIV BREF questionnaire was 86.08 ± 10.78. The lowest score was found in the environment domain (13.64 ± 2.06), while the highest score was found in the spirituality domain (15.54 ± 3.04). According to the multiple logistic regression analysis, participants, reported having an adequate income (OR = 3.32, P = 0.006), regularly taking meditation (OR = 3.79, P = 0.009), living in Tachileik (OR = 15.43, P = 0.011), and reported having no symptoms during previous 2 weeks (OR = 14.50, P < 0.001), were more likely to have good HRQoL level. In contrast, patients receiving ART < 1 year (OR = 0.163, P = 0.028) reported having low ART adherence (OR = 0.17, P = 0.018) and reported anticipated stigma (OR = 0.23, P < 0.001) and internalized stigma (OR = 0.29, P = 0.006) were less likely to have good HRQoL level. [ABSTRACT FROM AUTHOR]

This study aims to determine economic burden or cost of human immunodeficiency virus (HIV) and its consequences from patient perspective and to examine factors influencing the cost. This is a prevalence‐based cost‐of‐illness (COI) study. A cross‐sectional survey was carried out in Yangon, Myanmar during March and April 2018. Face‐to‐face structured interview was conducted among 264 people living with HIV (PLHIV) who were members of the selected four self‐help groups (SHGs) that provided HIV peer support. Micro‐costing approach was adopted for the cost calculation. Direct medical cost, direct non‐medical cost and indirect cost were considered. Cost of HIV per patient in the year 2017 was estimated at 228.2 international dollar (Int$). Direct medical cost was only small portion of the total cost (5.6%). Indirect cost or cost of time loss was the largest contributor among the cost components, accounted for 61.2% of the total cost. First year of the antiretroviral therapy (ART) initiation and second line drug regimen have positive effect on the costs. HIV resulted in substantial economic burden for the patients. Effective interventions aim at reducing the economic burden on patients by providing compensation on transportation cost and providing job opportunity are essential. Further researchers examining cost from provider and societal perspectives are warranted to provide complete picture of the economic burden of HIV in Myanmar. [ABSTRACT FROM AUTHOR]