{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T21:51:29Z","timestamp":1772142689422,"version":"3.50.1"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T00:00:00Z","timestamp":1593820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems\u2019 NCD care capacity. M\u00e9decins sans Fronti\u00e8res (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015\u201317 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4\u00a0206\u00a0481 (2015) to INT$6\u00a0739\u00a0438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015\u201317). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015\u201317. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and\/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.<\/jats:p>","DOI":"10.1093\/heapol\/czaa050","type":"journal-article","created":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T11:33:00Z","timestamp":1591961580000},"page":"931-940","source":"Crossref","is-referenced-by-count":16,"title":["Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study"],"prefix":"10.1093","volume":"35","author":[{"given":"\u00c9imh\u00edn","family":"Ansbro","sequence":"first","affiliation":[{"name":"Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Garry","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT,\u00a0UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Karir","sequence":"additional","affiliation":[{"name":"M\u00e9decins sans Fronti\u00e8res, Plantage Middenlaan 14 1018 DD Amsterdam,\u00a0The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amulya","family":"Reddy","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB,\u00a0UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran","family":"Jobanputra","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB,\u00a0UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taissir","family":"Fardous","sequence":"additional","affiliation":[{"name":"Health Economy Directorate, Ministry of Health, Pr. Hamzah St., Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zia","family":"Sadique","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH,\u00a0UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,7,4]]},"reference":[{"key":"2020101315544921900_czaa050-B1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13031-019-0192-2","article-title":"Host country responses to non-communicable diseases amongst Syrian refugees: a review","volume":"13","author":"Akik","year":"2019","journal-title":"Conflict and Health"},{"key":"2020101315544921900_czaa050-B2","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2337\/dc12-2625","article-title":"Economic costs of diabetes in the U.S. in 2012","volume":"36","year":"2013","journal-title":"Diabetes Care"},{"key":"2020101315544921900_czaa050-B3"},{"key":"2020101315544921900_czaa050-B4","doi-asserted-by":"crossref","first-page":"554","DOI":"10.14744\/AnatolJCardiol.2016.6999","article-title":"Cost of heart failure management in Turkey: results of a Delphi Panel","volume":"16","author":"Aras","year":"2016","journal-title":"The Anatolian Journal of Cardiology"},{"key":"2020101315544921900_czaa050-B5","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S2213-8587(15)00521-5","article-title":"Constraints and challenges in access to insulin: a global perspective","volume":"4","author":"Beran","year":"2016","journal-title":"The Lancet Diabetes & Endocrinology"},{"key":"2020101315544921900_czaa050-B6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.diabres.2010.03.029","article-title":"Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings","volume":"88","author":"Beran","year":"2010","journal-title":"Diabetes Research and Clinical Practice"},{"key":"2020101315544921900_czaa050-B7","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.3390\/ijerph6082258","article-title":"Chronic disease management in Sub-Saharan Africa: whose business is it?","volume":"6","author":"Bischoff","year":"2009","journal-title":"Int J Environ Res Public Health"},{"key":"2020101315544921900_czaa050-B8","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/S2213-8587(19)30083-X","article-title":"Challenges associated with providing diabetes care in humanitarian settings","volume":"7","author":"Boulle","year":"2019","journal-title":"The Lancet Diabetes & Endocrinology"},{"key":"2020101315544921900_czaa050-B9","volume-title":"Cost Analysis in Primary Health Care: A Training Manual for Programme Managers","author":"Creese","year":"1994"},{"key":"2020101315544921900_czaa050-B10","doi-asserted-by":"crossref","DOI":"10.1371\/currents.dis.53e08b951d59ff913ab8b9bb51c4d0de","article-title":"n-communicable diseases in emergencies: a call to action","author":"Demaio","year":"2013","journal-title":"PLoS Currents. doi: 10.1371\/currents.dis.53e08b951d59ff913ab8b9bb51c4d0de."},{"key":"2020101315544921900_czaa050-B11","doi-asserted-by":"crossref","first-page":"e0150088","DOI":"10.1371\/journal.pone.0150088","article-title":"Health service utilization among Syrian refugees with chronic health conditions in Jordan Wang Y (ed.)","volume":"11","author":"Doocy","year":"2016","journal-title":"PLoS One"},{"key":"2020101315544921900_czaa050-B12","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1186\/s12889-015-2429-3","article-title":"Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan","volume":"15","author":"Doocy","year":"2015","journal-title":"BMC Public Health"},{"key":"2020101315544921900_czaa050-B13","doi-asserted-by":"crossref","first-page":"e1001377","DOI":"10.1371\/journal.pmed.1001377","article-title":"Tackling non-communicable diseases in low- and middle-income countries: is the evidence from high-income countries all we need?","volume":"10","author":"Ebrahim","year":"2013","journal-title":"PLoS Medicine"},{"key":"2020101315544921900_czaa050-B14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/2052-3211-7-13","article-title":"Comparative assessment of medicine procurement prices in the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA","volume":"7","author":"Ewen","year":"2014","journal-title":"Journal of Pharmaceutical Policy and Practice"},{"key":"2020101315544921900_czaa050-B15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13031-018-0178-5","article-title":"What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? 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