Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania
<p><strong>Background</strong> The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ve...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Springer Nature
2023
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| _version_ | 1826310691789733888 |
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| author | Shah, HA Baker, T Schell, CO Kuwawenaruwa, A Awadh, K Khalid, K Kairu, A Were, V Barasa, E Baker, P Guinness, L |
| author_facet | Shah, HA Baker, T Schell, CO Kuwawenaruwa, A Awadh, K Khalid, K Kairu, A Were, V Barasa, E Baker, P Guinness, L |
| author_sort | Shah, HA |
| collection | OXFORD |
| description | <p><strong>Background</strong> The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ventilators in intensive care units) or more basic critical care such as Essential Emergency and Critical Care (EECC; e.g. vital signs monitoring, oxygen therapy, and intravenous fluids).</p>
<p><strong>Methods</strong> We investigated the cost effectiveness of providing EECC and advanced critical care in Tanzania in comparison with providing ‘no critical care’ or ‘district hospital-level critical care’ using coronavirus disease 2019 (COVID-19) as a tracer condition. We developed an open-source Markov model (https://github.com/EECCnetwork/POETIC_CEA) to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, a 28-day time horizon, patient outcomes obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. We performed a univariate and probabilistic sensitivity analysis to assess the robustness of our results.,</p>
<p><strong>Results</strong> EECC is cost effective 94% and 99% of the time when compared with no critical care (incremental cost-effectiveness ratio [ICER] 37 USD [−9 USD to 790 USD] per DALY averted) and district hospital-level critical care (ICER 14 USD [−200 USD to 263 USD] per DALY averted), respectively, relative to the lowest identified estimate of the willingness-to-pay threshold for Tanzania (101 USD per DALY averted). Advanced critical care is cost effective 27% and 40% of the time, when compared with the no critical care or district hospital-level critical care scenarios, respectively.</p>
<p><strong>Conclusion</strong> For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost effectiveness falls within the range considered ‘highly cost effective’. Further research is needed to explore the potential of EECC to generate even greater benefits and value for money when patients with diagnoses other than COVID-19 are accounted for.</p> |
| first_indexed | 2024-03-07T07:57:12Z |
| format | Journal article |
| id | oxford-uuid:3ad144dd-0103-404b-bda7-dbec3f6d8b32 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:57:12Z |
| publishDate | 2023 |
| publisher | Springer Nature |
| record_format | dspace |
| spelling | oxford-uuid:3ad144dd-0103-404b-bda7-dbec3f6d8b322023-08-31T08:29:37ZCost effectiveness of strategies for caring for critically ill patients with COVID-19 in TanzaniaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:3ad144dd-0103-404b-bda7-dbec3f6d8b32EnglishSymplectic ElementsSpringer Nature2023Shah, HABaker, TSchell, COKuwawenaruwa, AAwadh, KKhalid, KKairu, AWere, VBarasa, EBaker, PGuinness, L<p><strong>Background</strong> The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ventilators in intensive care units) or more basic critical care such as Essential Emergency and Critical Care (EECC; e.g. vital signs monitoring, oxygen therapy, and intravenous fluids).</p> <p><strong>Methods</strong> We investigated the cost effectiveness of providing EECC and advanced critical care in Tanzania in comparison with providing ‘no critical care’ or ‘district hospital-level critical care’ using coronavirus disease 2019 (COVID-19) as a tracer condition. We developed an open-source Markov model (https://github.com/EECCnetwork/POETIC_CEA) to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, a 28-day time horizon, patient outcomes obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. We performed a univariate and probabilistic sensitivity analysis to assess the robustness of our results.,</p> <p><strong>Results</strong> EECC is cost effective 94% and 99% of the time when compared with no critical care (incremental cost-effectiveness ratio [ICER] 37 USD [−9 USD to 790 USD] per DALY averted) and district hospital-level critical care (ICER 14 USD [−200 USD to 263 USD] per DALY averted), respectively, relative to the lowest identified estimate of the willingness-to-pay threshold for Tanzania (101 USD per DALY averted). Advanced critical care is cost effective 27% and 40% of the time, when compared with the no critical care or district hospital-level critical care scenarios, respectively.</p> <p><strong>Conclusion</strong> For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost effectiveness falls within the range considered ‘highly cost effective’. Further research is needed to explore the potential of EECC to generate even greater benefits and value for money when patients with diagnoses other than COVID-19 are accounted for.</p> |
| spellingShingle | Shah, HA Baker, T Schell, CO Kuwawenaruwa, A Awadh, K Khalid, K Kairu, A Were, V Barasa, E Baker, P Guinness, L Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title | Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title_full | Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title_fullStr | Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title_full_unstemmed | Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title_short | Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania |
| title_sort | cost effectiveness of strategies for caring for critically ill patients with covid 19 in tanzania |
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