Background

Following a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost.

Methods

In this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child’s hospital record was reviewed.

Results

In total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household’s monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household’s monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations.

Conclusions

Our findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.

中文翻译：

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马达加斯加 5 岁以下儿童的腹泻住院费用

背景

根据世界卫生组织的建议，马达加斯加于 2014 年引入了轮状病毒疫苗。尽管全国轮状病毒疫苗接种率保持在 <80%，但轮状病毒住院人数下降了 78%。疫苗联盟 Gavi 为轮状病毒疫苗提供了财政支持，但马达加斯加政府对财政成本的责任越来越大。

方法

在本次评估中，我们描述了公立儿科转诊医院 5 岁以下儿童腹泻导致的直接医疗、直接非医疗和间接疾病成本。在住院期间和住院后进行了一份由三部分组成的问卷调查，并审查了孩子的住院记录。

结果

该分析总共包括 96 名儿童。疾病总成本中位数为 156.00 美元（IQR：104.00, 210.86），直接医疗费用中位数为 107.22 美元。服务提供成本占住院费用的中位数为 44%；药物和诊断测试分别占住院总费用的 28% 和 20%。家庭支付的总疾病费用的中位数百分比为 67%。在收入低于 61 美元/月的家庭中，家庭支付的疾病费用中位数为 78.55 美元，占家庭每月支出的中位数为 168%。在每月收入超过 303 美元的家庭中，家庭支付的费用中位数为 147.30 美元，占家庭每月支出的中位数为 53%。在所有家庭收入水平中，

结论

我们的研究结果将有助于决策者评估轮状病毒疫苗的成本效益。这些结果还可以帮助医院管理人员和医疗保健提供者更好地了解家庭的财务限制。