Cost data
NEUMANN
This study adopted the cost classification proposed by Neumann et al.Formal healthcare costs were estimated using inpatient and outpatient administrative billing records for all visits reported at the study sites extracted for all patients over the study period. The daily cost of antibiotics was $1.110 for the control group, and $0.240–0.378 depending on the dose used for the intervention group. There was no difference in charges to trial participants versus non-trial patients with KLA. Only urine pregnancy testing, glucose-6-phosphate dehydrogenase assays, procalcitonin and blood collected for host studies, which were not considered standard of care, were covered by the study grant. Total charges were used as a proxy for hospital costs using a top-down approach, net of procedures and tests conducted only for study purposes.Singapore follows a mixed healthcare financing system with multiple payers, under which public hospitals are directly funded by the government using global budgets as well as prospective partial reimbursement based on diagnosis-related groups for inpatient and day-surgery services and per piece rates for outpatient visits. The public health insurance system, MediShield, covers inpatient and selected outpatient services. Premiums, deductibles, co-insurance, co-payments and costs above the claim limit may be paid out of balances held in nationally-mandated individual Medisave health savings accounts. Individuals may also elect to purchase supplemental private insurance coverage, or be covered by employer health insurance. The remaining expenditures are paid for out-of-pocket, with a number of means-tested supports for the low-income individuals including a general endowment fund, MediFund and other more targeted individual subsidy schemesOut-of-pocket transport expenses related to informal healthcare and productivity losses were collected via patient surveys at week 12 follow-up. Transportation costs included expenses incurred by the patient and anyone who accompanied the patient. Average self-reported transport costs for inpatient and outpatient visits were assumed to apply both ways to each visit.Productivity losses refer to the economic impact of reduced work productivity experienced by the patients or their caregivers. These economic losses stem from absence or resignation from paid employment. For individuals in paid employment, the losses were valued using the human capital approachCosts were denominated in 2018 Singapore Dollars (SGD), at the exchange rate of 1 SGD = 0.74 USD