Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis

Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life–saving critical care interventions in low–resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to sta...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Claudia Marotta, Francesco Di Gennaro, Luigi Pisani, Vincenzo Pisani, Josephine Senesie, Sarjoh Bah, Michael M. Koroma, Claudia Caracciolo, Giovanni Putoto, Fabio Amatucci, Elio Borgonovi
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2020
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/8321e334a8d44582995dd8342709225e
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:8321e334a8d44582995dd8342709225e
record_format	dspace
spelling	oai:doaj.org-article:8321e334a8d44582995dd8342709225e2021-12-02T11:13:50ZCost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis2214-999610.5334/aogh.2907https://doaj.org/article/8321e334a8d44582995dd8342709225e2020-07-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2907https://doaj.org/toc/2214-9996Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life–saving critical care interventions in low–resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource–poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective: To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods: The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings: 523 patients (median age 25 years, IQR 21–30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 – resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion: With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.Claudia MarottaFrancesco Di GennaroLuigi PisaniVincenzo PisaniJosephine SenesieSarjoh BahMichael M. KoromaClaudia CaraccioloGiovanni PutotoFabio AmatucciElio BorgonoviUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 86, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Claudia Marotta Francesco Di Gennaro Luigi Pisani Vincenzo Pisani Josephine Senesie Sarjoh Bah Michael M. Koroma Claudia Caracciolo Giovanni Putoto Fabio Amatucci Elio Borgonovi Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
description	Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life–saving critical care interventions in low–resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource–poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective: To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods: The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings: 523 patients (median age 25 years, IQR 21–30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 – resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion: With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.
format	article
author	Claudia Marotta Francesco Di Gennaro Luigi Pisani Vincenzo Pisani Josephine Senesie Sarjoh Bah Michael M. Koroma Claudia Caracciolo Giovanni Putoto Fabio Amatucci Elio Borgonovi
author_facet	Claudia Marotta Francesco Di Gennaro Luigi Pisani Vincenzo Pisani Josephine Senesie Sarjoh Bah Michael M. Koroma Claudia Caracciolo Giovanni Putoto Fabio Amatucci Elio Borgonovi
author_sort	Claudia Marotta
title	Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
title_short	Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
title_full	Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
title_fullStr	Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
title_full_unstemmed	Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis
title_sort	cost-utility of intermediate obstetric critical care in a resource-limited setting: a value-based analysis
publisher	Ubiquity Press
publishDate	2020
url	https://doaj.org/article/8321e334a8d44582995dd8342709225e
work_keys_str_mv	AT claudiamarotta costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT francescodigennaro costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT luigipisani costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT vincenzopisani costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT josephinesenesie costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT sarjohbah costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT michaelmkoroma costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT claudiacaracciolo costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT giovanniputoto costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT fabioamatucci costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis AT elioborgonovi costutilityofintermediateobstetriccriticalcareinaresourcelimitedsettingavaluebasedanalysis
_version_	1718396116245938176

Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis

Ejemplares similares