Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis. Issue 1 (20th July 2020)

• Record Type: Journal Article
• Authors: Marotta, Claudia; Di Gennaro, Francesco; Pisani, Luigi; Pisani, Vincenzo; Senesie, Josephine; Bah, Sarjoh; Koroma, Michael M.; Caracciolo, Claudia; Putoto, Giovanni; Amatucci, Fabio; Borgonovi, Elio
• Is Part Of: Annals of global health. Volume 86:Issue 1(2020)
• Publication Date: 2020-07-20
• Subjects: 362.1
• DOI: 10.5334/aogh.2907
• Languages: English
• ISSNs: 2214-9996

Abstract

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.