Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis
Objectives Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to a...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/10/e051055.full |
| _version_ | 1798027622654935040 |
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| author | Sebastian Suarez Daniel Sessler Jennifer Griffin Thomas Burke Stephen Charles Resch Moshood Olanrewaju Omotayo |
| author_facet | Sebastian Suarez Daniel Sessler Jennifer Griffin Thomas Burke Stephen Charles Resch Moshood Olanrewaju Omotayo |
| author_sort | Sebastian Suarez |
| collection | DOAJ |
| description | Objectives Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries.Setting Hospitals in Kenyan counties with low rates of caesarean delivery.Participants Patients needing emergency caesarean delivery in settings without availability of standard anaesthesia service.Interventions Simulated scales up of the ESM-Ketamine programme over 5 years (2020–24) was compared with status quo.Outcome measures Cost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo.Results Over 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario—a very good value for Kenya at less than 20% of per capita GDP per life-year gained.Conclusion In areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost. |
| first_indexed | 2024-04-11T18:54:23Z |
| format | Article |
| id | doaj.art-aa58b027ec6941ca8d38ecafafe58dd3 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-11T18:54:23Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-aa58b027ec6941ca8d38ecafafe58dd32022-12-22T04:08:14ZengBMJ Publishing GroupBMJ Open2044-60552022-10-01121010.1136/bmjopen-2021-051055Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysisSebastian Suarez0Daniel Sessler1Jennifer Griffin2Thomas Burke3Stephen Charles Resch4Moshood Olanrewaju Omotayo53Harvard T.H. Chan School of Public Health16 Cleveland Clinic, Cleveland, Ohio, USA1 Nutrition and Dietetics Research Group, Imperial College London, London, London, UKVice President and Chief Medical Officer, University of Texas, M.D. Anderson Cancer Center, Houston, TexasCenter for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USADivision of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USAObjectives Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries.Setting Hospitals in Kenyan counties with low rates of caesarean delivery.Participants Patients needing emergency caesarean delivery in settings without availability of standard anaesthesia service.Interventions Simulated scales up of the ESM-Ketamine programme over 5 years (2020–24) was compared with status quo.Outcome measures Cost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo.Results Over 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario—a very good value for Kenya at less than 20% of per capita GDP per life-year gained.Conclusion In areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost.https://bmjopen.bmj.com/content/12/10/e051055.full |
| spellingShingle | Sebastian Suarez Daniel Sessler Jennifer Griffin Thomas Burke Stephen Charles Resch Moshood Olanrewaju Omotayo Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis BMJ Open |
| title | Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis |
| title_full | Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis |
| title_fullStr | Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis |
| title_full_unstemmed | Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis |
| title_short | Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis |
| title_sort | non anaesthetist administered ketamine for emergency caesarean section in kenya cost effectiveness analysis |
| url | https://bmjopen.bmj.com/content/12/10/e051055.full |
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