Economic impact of switching from partially combined vaccine “Pentaxim® and hepatitis B” to fully combined vaccine “Hexaxim®” in the Malaysian National Immunization Program

Background The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents’/caregivers’ perceptions. Methods In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents’/caregivers’ questionnaire. Also, HCPs’ and parent’s/caregivers’ perceptions were investigated using structured questionnaires. Results The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects. Conclusions Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B. Trial registration Not applicable.

Negative effects of ant-plant interaction on pollination: costs of a mutualism

The mutualism of ants and extrafloral nectary (EFN)-bearing plants is known to reduce rates of herbivory. However, ants may have negative impacts on other mutualisms such as pollination, constituting an indirect cost of a facultative mutualism. For instance, when foraging on or close to reproductive plant parts ants might attack pollinators or inhibit their visits. We tested the hypothesis that ants on EFN-bearing plants may negatively influence pollinator behavior, ultimately reducing plant fitness (fruit set). The study was done in a reserve at Brazilian savannah using the EFN-bearing plant Banisteriopsis malifolia (Malpighiaceae). The experimental manipulation was carried out with four groups: control (free visitation of ants), without ants (ant-free branches), artificial ants (isolated branches with artificial ants on flowers) and plastic circles (isolated branches with plastic circles on flowers). We made observations on flower visitors and their interactions, and measured fruit formation as a proxy for plant fitness. Our results showed that pollinators hesitated to visit flowers with artificial ants, negatively affecting pollination, but did not hesitate to visit flowers with plastic circles, suggesting that they recognize the specific morphology of the ants. Pollinators spent more time per flower on the ant-free branches, and the fruiting rate was lower in the group with artificial ants. Our results confirm an indirect cost in this facultative mutualism, where the balance between these negative and positive effects of ants on EFN-bearing plants are not well known.

The Research on Total Factor Productivity of Soybean in China

This paper uses the panel stochastic frontier model to study the total factor productivity of Chinese soybean. The research shows that the impact of direct cost and labor cost on yield is positive and significant, the impact of indirect cost on yield is not significant, and the impact of cash cost on yield improvement is negative.

A STUDY ON UNIT COST OF DIET IN A TERTIARY CARE GOVERNMENT HOSPITAL

Aim:To study the diet cost per meal per patient admitted in a Tertiary Care Government Hospital. Objectives:To estimate direct cost, indirect cost and total unit cost of various types of diets. Methodology: It was a cross sectional, observational and descriptive type of study conducted in a tertiary care government hospital over a period of 4 weeks. Results: It was observed that the total cost of Normal diet was ₹122.8 per day per diet and ₹130.5 per day per diet for high protein diet.

The full cost of tonsillectomy at Children’s hospital 1 in 2019

Objective: Determine full cost of tonsillectomy at Children’s Hospital 1 in 2019. Methods: Coss–sectional descriptive study 304 tonsillectomy children at Children’s Hospital 1 in 2019. Results: The study results showed that the cost of tonsillectomy (excluding consultation fees and pre-operation tests) depend on surgery devices. The average cost of cautery tonsillectomy was 1,740, 869 VND (68% direct cost, 32% indirect cost), of the coblator tonsillectomy was 3,610,031 VND 84.58% direct cost, 15.46% indirect cost), and of the plasma peak tonsillectomy one was 3,600,124 VND (84.54% direct cost, 15.46% indirect cost). In 3 surgery methods, the percentage’s cost of drugs, medical disposible items, and operation team were the largest share in direct costs; in indirect costs, the percentage of human management was the highest proportion, followed by the percentage of facility maintenance cost, and the percentage of other regular expenses cost was very low. Conclusion: The average cost of cautery tonsillectomy was 1,740, 869 VND, of the coblator tonsillectomy was 3,610,031 VND, and of the plasma peak tonsillectomy one was 3,600,124 VND.This cost is higher than the current hospital fee the patient or the health insurance paid. This implies a mismatch between input costs and hospital rates. Key words: Tonsillectomy cost, Children’s Hospital 1, cautery, Coblator, Plasma Peak Blade.

Perhitungan Cost of Treatment pada Pasien Rawat Inap Penderita Stroke Peserta BPJS di RSUD dr. Mohamad Saleh Kota Probolinggo

Stroke merupakan salah satu penyakit katastropik yang menjadi penyebab kematian paling banyak di Indonesia. Kota Probolinggo merupakan kota dengan prevalensi stroke tertinggi kedua di Jawa Timur. Prevalensi dan kematian akibat stroke ini terus meningkat di RSUD dr. Mohamad Saleh Kota Probolinggo. Stroke merupakan penyakit berbiaya tinggi dan secara komplikasi dapat membahayakan jiwa, sehingga dibutuhkan pengelolaan pembiayaan yang tepat untuk menjamin efektifitas dan efisiensi pelayanan kesehatan penyakit ini. Oleh karena itu, perlu dilakukan studi mengenai cost of treatment yang mengukur biaya perawatan per episode layanan dari stroke. Tujuan penelitian ini untuk mengetahui gambaran perhitungan cost of treatment pada penderita stroke peserta BPJS di RSUD dr. Mohamad Saleh Kota Probolinggo. Studi ini merupakan studi evaluasi ekonomi parsial, dimana bertujuan untuk mendeskripsikan suatu objek biaya tanpa ada perbandingan terhadap intervensi lain yang dilakukan di RSUD dr. Mohamad Saleh Kota Probolinggo. Sampel penelitian adalah penderita stroke peserta BPJS di RSUD dr. Mohamad Saleh yang memenuhi kriteria inklusi dan eksklusi yaitu sebanyak 40 responden. Hasil penelitian menunjukkan rata-rata biaya langsung sebesar Rp 8.278.584. Rata-rata indirect cost sebesar Rp 974.383. Sedangkan rerata biaya per satu episode layanan stroke sebesar Rp 9.252.967. Saran yang diberikan adalah meningkatkan pencatatan tindakan keperawatan yang baik serta dilengkapi dengan tindakan koreksi ulang. Perlu dilakukan monitoring dan evaluasi berkala terhadap billing sebagai bentuk pengendalian biaya.