Cost-effectiveness analysis of a low-cost bubble CPAP device in providing ventilatory support for neonates in Malawi – a preliminary report

BMC Pediatrics

Scott B Cantor¹  Kondwani Kawaza²  Elizabeth Molyneux²  Rebecca Richards-Kortum⁴  Ashish A Deshmukh³  Ariel Chen⁵ 

[1]Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

[2]Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi

[3]Cancer Prevention Training Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

[4]Department of Bioengineering, Rice University, Houston, Texas, USA

[5]Institute for Global Health Technologies, Rice University, Houston, Texas, USA

关键词: Bubble continuous positive airway pressure;    Ventilatory support;    Sepsis;    Respiratory distress syndrome;    Prematurity;    Malawi;    Neonate;    Cost-effectiveness analysis;   

Others  :  1118896
DOI  :  10.1186/s12887-014-0288-1

 received in 2014-06-10, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

Background

A low-cost bubble continuous positive airway pressure (bCPAP) device has been shown to be an excellent clinical alternative to nasal oxygen for the care of neonates with respiratory difficulty. However, the delivery of bCPAP requires more resources than the current routine care using nasal oxygen. We performed an economic evaluation to determine the cost-effectiveness of a low-cost bCPAP device in providing ventilatory support for neonates in Malawi.

Methods

We used patient-level clinical data from a previously published non-randomized controlled study. Economic data were based on the purchase price of supplies and equipment, adjusted for shelf life, as well as hospital cost data from the World Health Organization. Costs and benefits were discounted at 3%. The outcomes were measured in terms of cost, discounted life expectancy, cost/life year gained and net benefits of using bCPAP or nasal oxygen. The incremental cost-effectiveness ratio and incremental net benefits determined the value of one intervention compared to the other. Subgroup analysis on several parameters (birth weight categories, diagnosis of respiratory distress syndrome, and comorbidity of sepsis) was conducted to evaluate the effect of these parameters on the cost-effectiveness.

Results

Nasal oxygen therapy was less costly (US$29.29) than the low-cost bCPAP device ($57.78). Incremental effectiveness associated with bCPAP was 6.78 life years (LYs). In the base case analysis, the incremental cost-effectiveness ratio for bCPAP relative to nasal oxygen therapy was determined to be $4.20 (95% confidence interval, US$2.29–US$16.67) per LY gained. The results were highly sensitive for all tested subgroups, particularly for neonates with birth weight 1– < 1.5 kg, respiratory distress syndrome, or comorbidity of sepsis; these subgroups had a higher probability that bCPAP would be cost effective.

Conclusion

The bCPAP is a highly cost-effective strategy in providing ventilatory support for neonates in Malawi.

【 授权许可】

   
2014 Chen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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