Health Economics Unit
Health Economics Unit
Khanam P.A.,BIRDEM General Hospital Dhaka |
Hoque S.,Khwaja Yunus Ali Medical College |
Begum T.,BIRDEM General Hospital Dhaka |
Habib S.H.,Health Economics Unit |
Latif Z.A.,BIRDEM Academy
Diabetes and Metabolic Syndrome: Clinical Research and Reviews | Year: 2017
Aims: The aim of this study was to determine the prevalence of microvascular complications and to identify the various risk factors related to these complications in subjects with diabetes. Materials and methods: The study was cross-sectional and conducted in Outdoor of BIRDEM, from July 2014 to December 2014. Subjects were considered at age 30 to 60 years and duration of diabetes was 2-10 years. Investigations included socio-demographic, anthropometry and blood pressure. Blood samples were collected for HbA1c, fasting plasma glucose (FBG), 2-h after breakfast (2-hBG), total cholesterol (chol), triglyceride (TG), LDL, HDL, Hb% and serum creatinine. All the complications were taken from the medical record books which was diagnosed by physician. Results: A total of 400 type 2 diabetes mellitus patients were investigated in this study. The mean and SD of age was 50.05. ±. 7.54. The male and female subjects were 41.5% and 58.5% respectively. The prevalence of diabetic retinopathy, nephropathy, neuropathy was 12.3%, 21.3% and 16.8% respectively. Logistic regression model estimated that increasing age (age. >. 50y; OR = 3.04; p. =<. 0.001), female participants (OR = 1.35; p = <. 0.04), rural patients (OR = 3.75; p. =<. 0.001), housewife (OR = 1.89; p. =<. 0.01) and retired patients (2.50; p = <. 0.03), lack of physical exercise, increasing HbA1c (p. =<0.001), FBG (p. =<. 0.001), 2-hBG (<0.001) and blood pressure (p = 0.000) had independent significant risk factors for any of three microvascular complications. Conclusion: This study observed that about all the microvascular complications were developed from first three years after registration at BIRDEM. Increasing age, HbA1c, FBG, 2-hBG and blood pressure had significant risk factors for any type of microvascular complications. © 2017 Diabetes India.
Katzenellenbogen J.M.,Curtin University Australia |
Katzenellenbogen J.M.,University of Western Australia |
Vos T.,University of Queensland |
Begg S.,Health Economics Unit |
Semmens J.B.,Curtin University Australia
Stroke | Year: 2011
Background And Purpose- Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997-2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia. Methods- Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status. Results- The total burden was 55 099 and 2134 disability-adjusted life years in non-indigenous and indigenous Western Australians, respectively. The indigenous to non-indigenous age-standardized stroke incidence rate ratio (15 years) was 2.6 in males (95% CI, 2.3-3.0) and 3.0 (95% CI, 2.6-3.5) in females, with similar rate ratios of disability-adjusted life years. The burden profile differed substantially between populations, with rate ratios being highest at younger ages. Conclusions- The differential between indigenous and non-indigenous stroke burden is considerable, highlighting the need for comprehensive intersectoral interventions to reduce indigenous stroke incidence and improve outcomes. Programs to reduce risk factors and increase access to culturally appropriate stroke services are required. The results here provide the quantitative basis for policy development and monitoring of stroke outcomes. © 2011 American Heart Association, Inc.
PubMed | Health Economics and Financing Research Group and Health Economics Unit
Type: Journal Article | Journal: International journal of health policy and management | Year: 2016
Measuring health status by using standardized and validated instrument has become a growing concern over the past few decades throughout the developed and developing countries. The aim of the study was to investigate the overall self-reported health status along with potential inequalities by using EuroQol 5 dimensions (EQ-5D) instrument among low-income people of Bangladesh.A cross-sectional household survey was conducted in Chandpur district of Bangladesh. Bangla version of the EQ-5D questionnaire was employed along with socio-demographic information. EQ-5D questionnaire composed of 2-part measurements: EQ-5D descriptive system and the visual analogue scale (VAS). For measuring health status, UK-based preference weights were applied while higher score indicated better health status. For facilitating the consistency with EQ-5D score, VASs were converted to a scale with scores ranging from 0 to 1. Multiple logistic regression models were also employed to examine differences among EQ-5D dimensions.A total of 1433 respondents participated in the study. The mean EQ-5D and VAS score was 0.76 and 0.77, respectively. The females were more likely to report any problem than the males (P < 0.001). Compared to the younger, elderly were more than 2-3 times likely to report any health problem in all EQ-5D dimensions (OR [odds ratio] = 3.17 for mobility, OR = 3.24 for self-care). However, the respondents of the poorest income group were significantly suffered more from every EQ-5D dimension than the richest income quintile.Socio-economic and demographic inequalities in health status was observed in the study. Study suggests to do further investigation with country representative sample to measure the inequalities of overall health status. It would be helpful for policy-maker to find a new way aiming to reduce such inequalities.
PubMed | Bangladesh Institute of Research and Rehabilitation in Diabetes, Health Economics Unit, Bangladesh Institute of Health science BIHS & Hospital, Research Training Management International and Government Homeopathic College
Type: Evaluation Studies | Journal: Asian journal of endoscopic surgery | Year: 2015
The purpose of this study was to examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy for uteri weighing more than 500g as compared to uteri weighing less than 500g in benign gynecological diseases.This was a retrospective study. Patients were admitted through the outpatient department. They were divided into two groups: uterine weight 500g (group1) and uterine weight >500g (group 2). There were no exclusion criteria based on the size, number, or location of leiomyomas. The patient characteristics for the two groups were compared in terms of demographic and socioeconomic details, operating time, amount of blood loss, requirement of blood transfusion, need for analgesia, and length of hospital stay.The characteristics age and BMI were well balanced between the two groups. Uterine weight was 267.297.6g in group 1 and 740.0371.4g in group 2 (P<0.001). Length of operation and amount of blood loss were greater in group 2 than in group 1 (operation: 89.126.7vs 73.324.6min, P<0.01; blood loss: 570.5503.6vs 262.5270.0mL, P<0.001). However, there was no significant difference in hospital stay or incidence of operative complications between the two groups. No patients were switched from laparoscopy to laparotomy during operation. The rate of blood transfusion was lower in group1 than in group 2 (4.9% vs 32.6%; P<0.001).This study demonstrated that despite the increased operating time and blood loss, laparoscopy should be considered instead of laparotomy in cases of large uteri. Laparoscopically assisted vaginal hysterectomy can be performed safely for a large uterus.
PubMed | Health Economics Unit, Bangabandhu Sheikh Mujib Medical University, Telenor Health, Institute of Public Health Nutrition and 4 more.
Type: Journal Article | Journal: Nagoya journal of medical science | Year: 2016
Unsafe food is linked to the deaths of an estimated two million people annually. Food containing harmful agents is responsible for more than 200 diseases ranging from diarrhoea to cancers. A one-sample pilot intervention study was conducted to evaluate the role of courtyard counselling meetings as the means of intervention for improving food safety knowledge and practices among household food handlers in a district of Bangladesh. The study was conducted in three phases: a baseline survey, the intervention and an end-line survey between April and November 2015 where 194 food handlers took part. Data were collected through observations and face-to-face interviews. The mean age of the respondents was 38.8 (12.4) years, all of whom were females. Hand washing before eating, and washing utensils with soap were significantly improved at the end-line in comparison to the baseline (57% vs. 40% and 83% vs. 69%, respectively). Hand washing with soap was increased by 4%. The mean score of food handling practices was significantly increased after the intervention (20.5 vs. 22.1; P<0.001). However, hand washing after use of toilet was unchanged after the intervention (75% vs.76%). Knowledge about safe food and the necessity of thorough cooking were significantly increased after the intervention (88% from 64% and 34% from 21%, respectively). Mean scores of knowledge and practice on food safety were significantly increased by 1.9 and 1.6, respectively after the one month intervention. Thus this food safety education in rural communities should be scaled up and, indeed, strengthened using the courtyard counselling meetings in Bangladesh.
PubMed | BIRDEM, BSMMU, Health Economics Unit, Bangladesh Medical College and 2 more.
Type: Journal Article | Journal: Journal of gynecological endoscopy and surgery | Year: 2015
The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery.A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon.There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.539.8 ml and 10032.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.3813.45 mg and 75.1816.45 mg), respectively.LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.
Norlin J.M.,Umeå University |
Norlin J.M.,The Swedish Institute for Health Economics |
Carlsson K.S.,The Swedish Institute for Health Economics |
Carlsson K.S.,Health Economics unit |
And 3 more authors.
Acta Dermato-Venereologica | Year: 2015
The introduction of biologics has changed treatment patterns as well as costs in patients with psoriasis. This study was performed to estimate direct and indirect costs of the psoriasis population in Sweden, and to analyse changes in costs between 2006 and 2009. The study population was identified in national registers. Direct costs included health care visits with primary psoriasis diagnoses in specialist care and drugs relevant for treating psoriasis. Productivity loss, including costs of long-term sick leave and disability pension, was estimated as the difference between psoriasis patients and matched controls from the general population. Total direct cost increased from SEK 348 million (∼ €39) in 2006 to SEK 459 million (∼ €51) in 2009, whereas the total productivity loss decreased from SEK 1,646 (∼ €183) to 1,618 million (∼ €180) between 2006 and 2009. Although direct costs, especially for biologic agents, have increased for patients with psoriasis over time, this study indicates that costs related to productivity loss are still more substantial. © 2015 Acta Dermato-Venereologica.
Habib S.H.,Health Economics Unit |
Biswas K.B.,BIRDEM |
Akter S.,BIRDEM |
Saha S.,Health Economics Unit |
Ali L.,Health Economics Unit
Journal of Diabetes and its Complications | Year: 2010
The economic burden resulting from diabetic foot consumes a major portion of resources. The study was undertaken to assess the cost-effectiveness of medical intervention in patients with diabetic foot. At baseline 906 patients were analyzed. Then 200 patients with diabetic foot were purposively selected from a tertiary diabetes care hospital. Of these, 100 were late in detection and poorly managed (late diabetic foot or LDF) and 100 were detected early and properly managed (early diabetic foot or EDF). Among 906 patients, 2.8% (25 patients) were found to develop diabetic foot. Total cost of treatment was US$13,308.16 with an average of US$443.60 per patient. Comparing the cost of patients who underwent amputation with the patients who are not yet amputated, cost difference was US$6657.74. The result showed that cost of amputation was 5.54 times higher than the usual treatment. The average cost of care was US$134 per patient. Among the average annual cost, LDF consumed US$18,918. Fifty percent of the costs were attributable to drugs for both groups of which 77% was for LDF and 29% to hospitalizations. The regression equation showed that medical cost is significantly related to complications. Proper management can substantially reduce the cost of care of patients with diabetic foot. © 2010 Elsevier Inc.
Habib S.H.,Health Economics Unit |
Saha S.,Health Economics Unit
Diabetes and Metabolic Syndrome: Clinical Research and Reviews | Year: 2010
Non-communicable diseases continue to be important public health problems in the world, being responsible for sizeable mortality and morbidity. Non-communicable diseases (NCDs) are the leading causes of death and disability worldwide. In 2005 NCDs caused an estimated 35 million deaths, 60% of all deaths globally, with 80% in low income and middle-income countries and approximately 16 million deaths in people less than 70 years of age. Total deaths from NCDs are projected to increases by a further 17% over the next 10 years. Knowing the risk factors for chronic disease means that approximately 80% premature heart disease and stroke, 80% of Type 2 diabetes and 40% of cancers are preventable. Within next 20 years, NCDs will be responsible for virtually half of the global burden of disease in the developing countries. Risk factors, such as tobacco and alcohol use, improper nutrition and sedentary behavior contribute substantially to the development of NCDs, which are sweeping the entire globe, with an increasing trend mostly in developing countries where, the transition imposes more constraints to deal with an increasing burden of over population with existing communicable diseases overwhelmed with increasing NCDs in poorly maintained sanitation and environment. By 2020, it is predicted that these diseases will be causing seven out of every 10 deaths in developing countries. A major feature of the developmental transition is the rapid urbanization and the large shifts in population from rural to urban areas. Even the rural people are increasingly adapting urbanized lifestyle. The changing pattern of lifestyle leads to the development of obesity, stroke, stress, atherosclerosis, cancer and other NCDs. Considering the future burden of NCDs and our existing health care system we should emphasize the need to prioritize the prevention and control of NCDs. Our strategies should be directed to monitor the incidence of NCDs along with their risk factors. Some NCDs have their common risk factors which should be addressed with minimum cost but maximum output. The three key components of the strategy are surveillance, health promotion and primary prevention, and management and health care. Accordingto the WHO criteria there are three steps for screening of NCDs. Step 1: Estimation population need through assessing the current risk profile and advocate for action. Step 2: Formulate and adopt NCD policy. Step 3: Identify policy implementation steps. Management of NCDs should be to increased awareness among the public regarding the signs and symptoms of the disease and its complications. Healthpromotion strategies, with a strong focus on disease prevention, are needed to em power people to act both individually and collectively to prevent risky behavior, and to create economic, political and environmental conditions that prevent NCDs and their risks. Risk trends need to be monitored and intervention strategies need to be evaluated with respect to their expected outcomes. Issues such as rapid population ageing, gender and income inequality, persistent poverty and the needs of developing countries require close consideration as they influence the prevalence of NCDs - and the success of interventions. © 2008 Diabetes India.
Selvaraj S.,Health Economics Unit |
Srivastava S.,Health Economics Unit |
Karan A.,Indian Institute of Public Health Delhi IIPHD
BMJ Open | Year: 2015
Objectives: The objectives of this study are to: (1) examine the pattern of price elasticity of three major tobacco products (bidi, cigarette and leaf tobacco) by economic groups of population based on household monthly per capita consumption expenditure in India and (2) assess the effect of tax increases on tobacco consumption and revenue across expenditure groups. Setting: Data from the 2011-2012 nationally representative Consumer Expenditure Survey from 101 662 Indian households were used. Participants: Households which consumed any tobacco or alcohol product were retained in final models. Primary outcome measures: The study draws theoretical frameworks from a model using the augmented utility function of consumer behaviour, with a two-stage two-equation system of unit values and budget shares. Primary outcome measures were price elasticity of demand for different tobacco products for three hierarchical economic groups of population and change in tax revenue due to changes in tax structure. We finally estimated price elasticity of demand for bidi, cigarette and leaf tobacco and effects of changes in their tax rates on demand for these tobacco products and tax revenue. Results: Own price elasticities for bidi were highest in the poorest group (-0.4328) and lowest in the richest group (-0.0815). Cigarette own price elasticities were -0.832 in the poorest group and -0.2645 in the richest group. Leaf tobacco elasticities were highest in the poorest (-0.557) and middle (-0.4537) groups. Conclusions: Poorer group elasticities were the highest, indicating that poorer consumers are more price responsive. Elasticity estimates show positive distributional effects of uniform bidi and cigarette taxation on the poorest consumers, as their consumption is affected the most due to increases in taxation. Leaf tobacco also displayed moderate elasticities in poor and middle tertiles, suggesting that tax increases may result in a trade-off between consumption decline and revenue generation. A broad spectrum rise in tax rates across all products is critical for tobacco control.