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This thesis examines the challenges involved in transferring economic evaluation costing results between different health care settings. The first chapter suggests that improving the transferability of costing results is important for two main reasons. Firstly, if cost data are transferable this could allow policy makers in one location to use the cost results of a study from a different location and apply these to their own setting. Secondly, to maximise the ability to synthesise costing results within a multi-centre study, the data need to be transferable across the participating study centres/countries. In terms of factors which influence the transferability of costs results, a major consideration is the underlying economic heterogeneity of alternative health care settings. In addition the chapter identifies three main factors with scope for improvement, namely the reporting, standardisation and transparency of cost data, which are addressed throughout the thesis. Chapter 2 highlights that in terms of economic evaluation methodology, greater attention has been devoted to the benefit component compared to costing methodology. The chapter goes onto reveal that although costing issues such as discounting are increasingly being taken into account by health economists, there are other areas with clear scope for methodological development. In particular, the calculation of unit costs, the level of detail in collecting cost data, patient cost measurement and the conversion of cost results into a common currency are described. A description of the clinical area for this thesis, end-stage renal disease (ESRD), is provided in Chapter 3. The aim of Chapter 4 is to examine the choice of approach taken to calculate unit costs in multi-centres studies. The empirical work presented in Chapter 5 explores whether detailed unit costing approaches (bottom-up) might be necessary and favourable to more readily available costs (top-down), even if this implies a greater use of data collection resources. The focus of the thesis moves from health service costing to patient costing and the notion of a societal perspective in Chapter 6. Chapter 7 addresses the issue of reporting costing results by converting cost results into a common currency base. The main approaches to converting costs, namely exchange rates and published purchasing power parities (PPPs) are described, along with their respective limitations.

Text in English with abstracts in English and isiZulu / Poor adherence to their prescribed diet, medications and treatment contributes to increased mortality and morbidity in patients with end-stage renal disease. These patients must change their diet when receiving dialysis treatment, but cultural beliefs and practices can affect their adherence to the prescribed diet. The purpose of this qualitative, descriptive, exploratory study was to improve health education on prescribed diet adherence to patients living on haemodialysis at a haemodialysis unit in eThekwini Municipality. Data from a sample of 20 patients was collected using semi-structured interviews and analysed using qualitative content analysis. The findings revealed that haemodialysis patients’ prescribed diet adherence was influenced by cultural and religious views, and by family support. Food availability, patients’ geographical location and patients’ financial means hindered their adherence to their prescribed diet. A multi-disciplinary health care team including nurses, should be sensitive to patients’ different cultural beliefs and practices when providing health education. / Ukungabambeleli endleleni emisiwe yokudla, amakhambi nasekwelashweni kunomthelela ekwandiseni izimpawu zesifo sezinso esingapheli (ESRD) futhi kwandisa isibalo sabantu ababulawa yilesisifo. Iziguli ezinalesisifo zidinga ukushitsha indlela yokuphila, iziphuzo kanye nokulandela indlela emisiwe yokudla kakhulukazi mabe ngaphansi kokwelashwa ngokuhlanzwa kwegazi ngomshini (dialysis). Izinkolelo zamasiko nendlela zokuphila ezihambisana namasiko kwenze imfundiso nge ezempilo maqondana nendlela emisiwe yokudla yaba lukhuni. Inhloso yalolucwaningo bekuwukwandisa ulwazi nemfundiso ngezempilo mayelana nokulandela indlela emisiwe yokudla kwiziguli izithola ukulashwa ngokuhlanzwa kwegazi ngomshini (haemodialysis) esikhungweni esikuMasipala weTheku. Kusetshenziwe indlela yokwenza ucwaningo esezingeni elifanele, Imininingwano eqoqiwe eqembini (sample) leziguli ezingamashumi amabili (20) ezithola ukwelashwange haemodialyisis. Imininigwane iqoqwe kusetshenziswa izingxoxo ezihleliwe. Imigomo elawula ukuhlaziya ilandeliwe yonke ngenkathi kwenziwe lolucwaningo. Lolucwaningo luveze ukuthi indlela yokudla emisiwe yeziguli ezikwi dialysis iphazanyiswa imobono yamasiko, inkolo kanye nokusekelwa nokuzimbandakanya kwamalungu omndeni. Izinselelo ezinjengokutholakala, indawo isiguli esihlala kuyo nezinkinga zemali zivimbela ukubambelela endleleni emisiwe yokudla. Abasebenzi bezempilo kumele banakekele indima edlalwa izinkolelo namasiko uma befundisa ngezempilo ezigulini eziphethwe izinso. / Nursing Science / M.A. (Nursing Science)