Journal article
Cost effectiveness of strategies for caring for critically ill patients with COVID-19 in Tanzania
- Abstract:
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Background 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).
Methods 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.,
Results 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.
Conclusion 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.6MB, Terms of use)
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- Publisher copy:
- 10.1007/s41669-023-00418-x
Authors
- Publisher:
- Springer Nature
- Journal:
- PharmacoEconomics - Open More from this journal
- Volume:
- 7
- Issue:
- 4
- Pages:
- 537–552
- Place of publication:
- Switzerland
- Publication date:
- 2023-05-13
- Acceptance date:
- 2023-04-27
- DOI:
- EISSN:
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2509-4254
- ISSN:
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2509-4262
- Pmid:
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37178434
- Language:
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English
- Keywords:
- Pubs id:
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1343441
- Local pid:
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pubs:1343441
- Deposit date:
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2023-06-14
- ARK identifier:
Terms of use
- Copyright holder:
- Shah et al.
- Copyright date:
- 2023
- Rights statement:
- © The Author(s) 2023. Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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