The Barbados Health of the Nation Survey – Cost Sub‐Study

Investigators:

Angela MC Rose (PhD Candidate), Ian Hambleton, Nigel Unwin Chronic Disease Research Centre

Funding Obtained:

Included within the total for the main study

Start Date:

October 2011

End Date: December 2013

Rationale:

There is little information on the cost of non‐communicable diseases (NCDs) in the Caribbean. This study will provide the first detailed assessment of the cost of acute myocardial infarction (MI) and stroke in Barbados, from the perspectives of the national healthcare system and the individual. It will also provide information on the quality of life of cardiovascular disease (CVD) patients.

Methods:

This was a ‘bottom‐up’ cost‐of‐illness study on all 1‐year survivors of acute MI and stroke diagnosed in 2011 (cases) and all participants from the Health of the Nation Study (noncases). Information was collected by questionnaire on 1 year of healthcare service use including the main drivers of cost for the healthcare provider (length of hospital stay and major surgical procedures). For the individual perspective, information was also collected on number of days spent off work and time spent on medical visits during the previous year.

Main Results and Further Analyses:

Unit cost data were obtained from the single tertiary public hospital and from various private healthcare services across the island. Questionnaires were completed for 268 acute MI and stroke survivors and 1234 HotN participants, with analysis in progress. Further analyses will include comparisons of quality of life estimates for cases and noncases.

Expected impact:

The findings from this study will be used to provide, for the first time, cost estimates for acute MI and stroke in Barbados.

Next Steps / Future Plans:

Further analyses, as described above.

Publications:

the two main planned publications are (1) The cost of cardiovascular disease in Barbados; and (2) The quality of life of CVD patients in Barbados.

Training opportunities:

This study comprises part of Ms Rose’s PhD, together with data from the first 5 years of the BNR. Her supervisory team includes Dr Alafia Samuels, UWI Cave Hill Faculty of Medical Sciences and Dr E Arthur Phillips, Barbados Ministry of Health.

Research activities: surveillance programme, CDRC

• Surveillance of the ill (national, population‐based, multi‐disease registry)
• Surveillance of the well (national, population‐based surveys)

Reports of work conducted

• Surveillance of the ill
  • Annual reports for CVD registries for each year since inception (2009–2013) completed and submitted to Ministry of Health.
  • First 5‐year analyses completed for CVD registries; briefing report submitted. Data show high mortality and fatality for both stroke and heart attack, with stable (low) incidence
    • Data collected for study of ambulance times for stroke; analyses in preparation
    • Data collected for study of ICU bed occupation by CVD patients; analyses in preparation

  • Analysis for first year of BNR‐Cancer completed; report in preparation

• Surveillance of the well
  • All data collected and analyses complete for HotN core study; report submitted to MoH and in process of being published; main papers in preparation
  • All data collected for four HotN sub‐studies; analyses complete (physical activity, cost) or underway (salt intake, diabetic foot)

• Research projects (combining data from surveillance of ill and well)
  • Barbados COAST study: examining the cost of acute MI and stroke in Barbados. Combines information from CVD cases using the registry and HotN participants as comparison group. Data collected and analyses underway

  Proposals for new work

  • Surveillance of the ill
    • Extending the multi‐disease surveillance concept to include other important health outcomes (e.g. diabetic amputations)

  • Research projects using surveillance data
    • Investigations into possible reasons for high mortality from stroke and heart attack in Barbados
      • link to future disparities work (Project 6: Understanding Caribbean differences in CVD/DM)

    • An investigation of quality of life among CVD survivors, compared with the general population

  • Surveillance methodological work
    • Methods for reporting cancer statistics in small island states
    • Further development of the multi‐disease surveillance model in Barbados to be relevant for, and disseminated to other small island developing states

  • Surveillance of the well
    • Quinquennial rolling national NCD risk factor surveys (STEPS‐plus)