Zoë M McLaren1, Alana Sharp1, John P Hessburg2, Amir Sabet Sarvestani3, Ethan Parker1, James Akazili4, Timothy R B Johnson5, Kathleen H Sienko6. 1. Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. 2. Department of Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125USA. 3. Design Science Program, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125, USA. 4. Navrongo Health Research Centre, Navrongo, Upper East, Ghana. 5. Department of Obstetrics & Gynecology, Medical School, University of Michigan, L4000 Womens SPC 5276, Ann Arbor, MI 48109-5276, USA. 6. Departments of Mechanical and Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 3454 GG Brown, Ann Arbor, MI 48109-2125, USA.
Abstract
BACKGROUND: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). METHODS: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. RESULTS: Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. CONCLUSIONS: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.
BACKGROUND: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). METHODS: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. RESULTS: Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. CONCLUSIONS: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.
Entities:
Keywords:
cost-effectiveness analysis; global health; low resource settings; low-income and middle-income countries; maternal mortality; medical devices; pre-eclampsia
Authors: Bruce Y Lee; Angela R Wateska; Rachel R Bailey; Julie H Y Tai; Kristina M Bacon; Kenneth J Smith Journal: Vaccine Date: 2010-10-16 Impact factor: 3.641
Authors: Douglas Altman; Guillermo Carroli; Lelia Duley; Barbara Farrell; Jack Moodley; James Neilson; David Smith Journal: Lancet Date: 2002-06-01 Impact factor: 79.321
Authors: Kate E Duhig; Annemarie De Greeff; Andrew Van Der Westhuizen; Elinor Baker; Andrew H Shennan Journal: Blood Press Monit Date: 2009-06 Impact factor: 1.444
Authors: Cesar G Victora; Jennifer Harris Requejo; Aluisio J D Barros; Peter Berman; Zulfiqar Bhutta; Ties Boerma; Mickey Chopra; Andres de Francisco; Bernadette Daelmans; Elizabeth Hazel; Joy Lawn; Blerta Maliqi; Holly Newby; Jennifer Bryce Journal: Lancet Date: 2015-10-22 Impact factor: 202.731
Authors: Liona C Poon; Andrew Shennan; Jonathan A Hyett; Anil Kapur; Eran Hadar; Hema Divakar; Fionnuala McAuliffe; Fabricio da Silva Costa; Peter von Dadelszen; Harold David McIntyre; Anne B Kihara; Gian Carlo Di Renzo; Roberto Romero; Mary D'Alton; Vincenzo Berghella; Kypros H Nicolaides; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2019-05 Impact factor: 3.561