BACKGROUND

The Division of Colorectal Surgery at the Philippine General Hospital (PGH) conducts hundreds of surgeries annually for benign and malignant colorectal conditions. Since 2019, the Division has implemented an Enhanced Recovery After Surgery (ERAS) program to improve patient outcomes. However, its impact on hospital costs—critical for a government hospital—has not yet been studied.

This study aimed to evaluate the effect of ERAS on healthcare costs for elective colorectal surgeries performed at PGH in 2021.

A retrospective observational study was conducted on adult patients who underwent elective colorectal surgeries under the ERAS protocol in 2021. Medical and billing records were retrieved using the hospital’s electronic medical records (EMR) system, excluding cases with incomplete data. Procedures were categorized by type [stoma closure, colonic or rectal resection, reversal of Hartmann’s, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)] and surgical approach (open, laparoscopic, or robotic). Costs were classified into diagnostics, facility fees, medications, surgery, and hospital supplies. ERAS compliance rates were extracted from the online ERAS Interactive Audit System (EIAS), and linear regression analysis was performed.

Among 114 elective colorectal surgeries, records for 90 cases were analyzed. Surgery-related expenses accounted for the highest mean hospital costs across all procedure types. An inverse correlation between ERAS compliance and total cost was observed for open surgeries, with statistically significant reductions in stoma closures and open colon resections (p-value: 0.0213 and 0.0134, respectively). However, minimally invasive surgeries (MIS) did not demonstrate cost reductions with increasing ERAS compliance, likely due to additional expenses associated with advanced equipment. Linear regression indicated that higher compliance rates generally led to decreased hospital costs.

Standardized care through ERAS has been associated with cost savings compared to traditional perioperative management. This study supports the conclusion that higher ERAS compliance can reduce hospital costs in open colorectal surgeries. However, the higher costs of MIS procedures, driven by equipmentrelated expenses, may offset potential savings from ERAS adherence. Further research is warranted to explore the cost implications of ERAS in MIS cases.

BACKGROUND AND OBJECTIVE

Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.

We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.

Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.

Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

Costs And Cost Analysis ; Delivery Of Health Care

OBJECTIVES

During the early COVID-19 pandemic (2020 to mid-2021), the Philippine government relied on nonpharmaceutical interventions such as lockdowns and Enhanced Community Quarantine (ECQ). With the emergency use authorization of vaccines, assessing their potential impact became essential. This study develops a Philippine model to evaluate the epidemiologic and economic effects of COVID-19 vaccination, estimating its impact on mortality, hospitalization, and mild/asymptomatic cases under various prioritization strategies, including booster doses and the presence of variants of concern.

A dynamic transmission model (DTM) with an SEIR (Susceptible-Exposed-Infected-Recovered) structure was calibrated using local data, including case numbers, deaths, seroprevalence, vaccination coverage, and intervention costs. The model’s outputs informed a cost-effectiveness analysis (CEA) from health system and societal perspectives over a two-year horizon. Incremental Cost-Effectiveness Ratios (ICERs) were calculated, with costs adjusted to 2020 prices and discount rates of 3%-10% applied. Sensitivity analyses, including one-way and probabilistic approaches, assessed robustness, while a budget impact analysis (BIA) estimated government expenditures in 2020 and 2021.

Without vaccination, daily cases could have peaked at 400,000 between February and May 2021. A vaccination campaign was projected to reduce cases to around 20,000, significantly lowering mortality.  

From the health system perspective, the estimated cost without vaccination was PhP 14.46 trillion, with 93.83 million QALYs. With vaccination, costs dropped to PhP 2.36 trillion, while QALYs increased to 101.79 million. From the societal perspective, costs were PhP 14.68 trillion without vaccination and PhP 2.38 trillion with vaccination, with the same QALY outcomes.

CEA results confirmed that vaccination was cost-saving, with ICERs of -PhP 1,520,727.28 per QALY (health system) and -PhP 1,546,171.63 per QALY (societal). Sensitivity analyses supported these findings, with oneway sensitivity analysis showing minimal impact from parameter changes and probabilistic sensitivity analysis confirming cost-saving outcomes. The BIA estimated government expenditures of PhP 983.45 billion in 2020 and PhP 1.47 trillion in 2021 for the vaccine scenario, lower than the no-vaccine scenario.

Indeed, our modeling has shown that COVID-19 vaccines could mitigate the spread of COVID-19 and provide good value for money.

OBJECTIVES

The burden of oral diseases is high in the Philippines. The global burden of disease study in 2019 estimated that 44 million Filipinos are affected by oral disorder. More specifically, 29 million Filipinos have untreated dental caries. Outpatients' dental health services are not covered by PhilHealth benefit package. There is a need to include key oral health interventions such as basic prevention and treatment in PhilHealth benefit package to be delivered at the primary health care settings (WHO TSA 153980). The study aimed to determine the incremental cost-effectiveness ratio (ICER) of a set of oral health care services to be delivered at different levels of health care within a comprehensive PhilHealth benefit package.

This study evaluates the cost-effectiveness of including basic oral health services in the PhilHealth benefit package using a Markov modelling approach. The target population consists of Filipino adults and children at risk for dental diseases who are potential beneficiaries of PhilHealth. The intervention under consideration includes dental consultation, oral prophylaxis, topical fluoride application, silver diamine fluoride application, dental filling, and tooth extraction. The comparator is the current standard of care, which involves out-of-pocket payments for oral health services or limited access to subsidized dental care. The primary outcomes assessed include the incremental costeffectiveness ratio (ICER) per quality-adjusted life year (QALY) gained. A Markov model was constructed with a time horizon of 50 years to simulate the lifespan of Filipinos up to the average life expectancy of 70 years old, using a cycle length of one year to reflect disease progression and treatment effects overtime. Model parameters were derived from literature and expert opinion. Sensitivity analyses, including one-way and probabilistic sensitivity analyses, were conducted to assess uncertainty in model inputs. The analysis was carried out from a societal perspective incorporating direct medical and non-medical costs, and indirect costs.

A Markov model showed that a subsidized package is a cost-effective approach compared to the current situation of no subsidy, with an ICER of PhP 75,636 (1,535.76 USD) per disability adjusted life year (DALY) averted. The computed ICER was considered good value for money as it was below 2021 GDP per capita of the Philippines of PhP 174,286 (3,538.80 USD). One-way sensitivity analysis showed that the cost of preventive treatment had the most significant impact on the model, and a price threshold of greater than PhP 3,062 (62.17 USD) for preventive treatment will render the subsidized package no longer cost-effective. The budget impact analysis showed a 1.63% increase in budget annually with the current situation of no subsidy. Rolling out a subsidized oral health package will entail a significant increase in government expenses during the first year but a decreasing trend of 1-2% annually for the following years as the program takes its effect.

A subsidized oral health package is a costeffective approach from a societal perspective. It will entail a significant increase in government expenditure during the start of its roll out but will eventually result in a decreasing trend of expenses as the years progress.

BACKGROUND

The World Health Organization (WHO) estimates that in 2015, approximately 325 million or 4.4% of the global population were living with chronic hepatitis B or hepatitis C infection. In the same year, around 1.34 million died from this disease.

This study aimed to estimate the burden of hepatitis B in the Philippines and to determine the costeffectiveness of possible interventions.

This study utilized the Center for Disease Analysis Foundation’s (CDAF’s) mathematical disease burden model of hepatitis B. Model inputs were collected using literature review, key informant interviews, expert panel interviews, and records review, and were validated through a series of round table discussions with experts.

Results show that in 2017, the prevalence of chronic hepatitis B infection in the Philippines was 9.7%, equivalent to 10 million infected individuals. Although the model projects a decreasing trend in chronic hepatitis B virus (HBV) infections, liver-related mortality and morbidity due to these viruses are expected to rise if the status quo is maintained. Results show that substantial increase in government subsidy for WHO elimination scenarios would be required to achieve cost-effective outcomes.

Hepatitis B remains a huge problem in the Philippines. The HBV modelling exercise reveal that it will be worthwhile and cost-effective to adhere to the WHO elimination targets. A substantial financial investment will be necessary to do so, specifically a significant scale up in the screening, diagnosis, treatment, and monitoring of patients with HBV. While this modelling exercise does not yield burden of disease as accurate as a prevalence survey, experts consulted in the round table discussions agreed with the modelling inputs.

Objectives: This study aims to analyze the cost of patient care among ORL-HNS patients admitted in a tertiary, teaching government hospital in a low- to middle-income country. Methods: This is a prevalence-based, prospective, bottom-up, cost-of-illness analysis among patients of the Department of Otorhinolaryngology-Head and Neck Surgery in a tertiary training government hospital admitted from July 2021 to March 2022. The value assessment method used is the human capital approach. The societal perspective is used for analysis to estimate and reflect payer (insurance providers) and patient perspectives. Results: A total of one hundred fifty seven (157) patients were admitted for elective surgery under the service of ORL-HNS consisting of 75 females and 82 males. The average total overall cost was $3,851.10 (Php 199, 870.50 ± 164, 725.60). The total direct health care cost for all patients within the study period amounted to $3,712.18 (Php 192, 662.22 ± 159, 548.60) while the direct non-health care cost was $58.60. The workforce cost (58.5%) and medication cost (18.8%) comprised the majority of in-patient expenses with a mean cost of $2,221.36 (Php 37,083.66) and $714.51 (Php 44,363.14), respectively. In this study, an average of $80.29 was lost due to illness and hospitalization (± $81.74). The total PHIC coverage pays a range from zero to 67.5% with an average coverage of only 17%. Conclusion Our analysis has shown that workforce and medication expenses are the main cost drivers for the direct healthcare costs among Otolaryngology patients admitted for elective procedures. Stakeholders, such as the otolaryngologists and hospitals should coordinate closely to create a more encompassing coverage of Philhealth to prevent patients from suffering from financial crises due to their illness.
Costs and Cost Analysis ; Otolaryngology ; Philippines

Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

Background and Objective: Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies. Methods: We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty. Results: Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve. Conclusion Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.
Scabies ; Ivermectin ; Permethrin ; Cost-Benefit Analysis

Objective: This paper aims to provide a better understanding of the different engagement, cost, and resource considerations in developing and implementing mHealth solutions in the Philippines during the COVID-19 pandemic. Methods: First, six participants completed a form to document the estimated costs of developing a pseudo mobile application with features to mitigate the pandemic. Second, ten key informant interviews determined the facilitators, barriers, and resource requirements in developing mHealth tools. Results: The average cost estimate to develop and roll out a mobile application with public health and epidemiology features is Php 4,018,907 (US $78,650). The analysis of the interviews resulted in 12 themes organized in three domains: 1) facilitators and barriers in developing and sustaining mHealth solutions; 2) costs of sustaining mHealth technologies; and 3) factors affecting the costs of development and maintenance of mHealth technologies. Conclusion While differences in the cost estimates are evident, it provides a ballpark figure and the different factors that implementers need to sustain and maintain an mHealth solution. This paper hopes to inform policies and practices in engaging technology solution partners and in scaling up mHealth technologies.
Telemedicine ; COVID-19 ; Costs and Cost Analysis