Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya.
COVID-19
health economics
health systems
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
11
08
2021
accepted:
17
11
2021
entrez:
8
12
2021
pubmed:
9
12
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions. We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results. The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya's cost-effectiveness threshold (US$908). When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.
Sections du résumé
BACKGROUND
Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions.
METHODS
We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results.
RESULTS
The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya's cost-effectiveness threshold (US$908).
CONCLUSION
When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.
Identifiants
pubmed: 34876459
pii: bmjgh-2021-007168
doi: 10.1136/bmjgh-2021-007168
pmc: PMC8655343
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
ID : 092654
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Am J Trop Med Hyg. 2020 Dec;103(6):2419-2428
pubmed: 33009770
Lancet Glob Health. 2015 Nov;3(11):e712-23
pubmed: 26475018
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Lancet. 2021 Jan 16;397(10270):220-232
pubmed: 33428867
PLoS One. 2020 Jul 20;15(7):e0236308
pubmed: 32687538
BMJ Glob Health. 2021 Apr;6(4):
pubmed: 33853843
Lancet Infect Dis. 2020 Oct;20(10):1115-1117
pubmed: 32888409
Science. 2021 Nov 19;374(6570):989-994
pubmed: 34618602
Lancet Respir Med. 2020 May;8(5):506-517
pubmed: 32272080
BMC Health Serv Res. 2021 Jan 22;21(1):82
pubmed: 33482807
BMJ Glob Health. 2018 Nov 5;3(6):e000964
pubmed: 30483412
JAMA. 2020 Apr 7;323(13):1239-1242
pubmed: 32091533
Int J Surg. 2020 Jun;78:185-193
pubmed: 32305533
EClinicalMedicine. 2020 Aug;25:100471
pubmed: 32840491
PLoS One. 2021 Apr 30;16(4):e0251085
pubmed: 33930079
JAMA. 2020 Aug 11;324(6):603-605
pubmed: 32644129
Value Health. 2016 Dec;19(8):929-935
pubmed: 27987642
Health Policy Plan. 2001 Sep;16(3):326-31
pubmed: 11527874
Gates Open Res. 2020 Nov 30;4:176
pubmed: 33575544
J Med Virol. 2021 Mar;93(3):1449-1458
pubmed: 32790106
Popul Health Metr. 2015 Apr 03;13:10
pubmed: 26778920