Publication: Cost-utility of intermediate obstetric critical care in a resource-limited setting: A value-based analysis
Issued Date
2020-01-01
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ISSN
22149996
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2-s2.0-85088906567
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Mahidol University
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SCOPUS
Bibliographic Citation
Annals of Global Health. Vol.86, No.1 (2020), 1-8
Suggested Citation
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. Annals of Global Health. Vol.86, No.1 (2020), 1-8. doi:10.5334/aogh.2907 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58325
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Title
Cost-utility of intermediate obstetric critical care in a resource-limited setting: A value-based analysis
Abstract
© 2020 The Author(s). 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 invest-ment 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.