Pre‐Hospital Pulse‐Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost‐Effectiveness Analysis
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Wiley
2025
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| _version_ | 1867008199692910592 |
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| author | James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith |
| author_facet | James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith |
| collection | Wiley Open Access |
| contents | Pre‐Hospital Pulse‐Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost‐Effectiveness Analysis James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith Pediatric Pulmonology ABSTRACT Background Pneumonia is the leading cause of death globally in children aged 0–5 years. Early access to pulse‐oximetry and supplemental oxygen in low‐resource, pre‐hospital settings may result in improved pediatric pneumonia outcomes. However, few data exist regarding their application in such settings. Methods We performed an exploratory cost‐effectiveness analysis using a decision analytic model to examine use of pulse‐oximetry and supplemental oxygen in pre‐hospital environments of Malawi. Results Our model yielded an Incremental Cost‐Effectiveness Ratio (ICER) for pre‐hospital pulse‐oximetry use of $35 (USD) per disability‐adjusted life‐year (DALY) averted compared to no pulse‐oximetry use. One‐way sensitivity analysis showed highest sensitivity to the parameter of downstream hospitalization cost. Given that inpatient management is the standard of care for hypoxemic pneumonia, when only pre‐hospital costs were considered the result was an ICER of $9.9/DALY averted. Both values were considered cost‐effective according to a conservative willingness‐to‐pay (WTP) threshold set for 1x the average GDP per capita in Malawi ($588, 2018). When oxygen was analyzed in combination with pulse‐oximetry, we found a baseline WTP threshold for pre‐hospital oxygen of $71 per patient. For every 1% reduction in total pediatric pneumonia mortality consequent to pre‐hospital oxygen use, we determined the recommended WTP allowance for oxygen would increase by approximately $4.53. Conclusion We conclude that pulse‐oximetry is likely cost‐effective in low‐resource, pre‐hospital environments. We acknowledge the need for further research on the effectiveness of pre‐hospital oxygen in reducing pediatric pneumonia mortality and suggest ranges of cost and efficacy for which oxygen is likely to be found cost‐effective in tandem with pulse‐oximetry. 10.1002/ppul.71095 http://creativecommons.org/licenses/by-nc/4.0/ |
| doi_str_mv | 10.1002/ppul.71095 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_ppul_71095 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Pre‐Hospital Pulse‐Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost‐Effectiveness Analysis James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith Pediatric Pulmonology Pre‐Hospital Pulse‐Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost‐Effectiveness Analysis James B. Newton Michael T. Hawkes Eugene Katenga‐Kaunda Kenneth J. Smith Pediatric Pulmonology ABSTRACT Background Pneumonia is the leading cause of death globally in children aged 0–5 years. Early access to pulse‐oximetry and supplemental oxygen in low‐resource, pre‐hospital settings may result in improved pediatric pneumonia outcomes. However, few data exist regarding their application in such settings. Methods We performed an exploratory cost‐effectiveness analysis using a decision analytic model to examine use of pulse‐oximetry and supplemental oxygen in pre‐hospital environments of Malawi. Results Our model yielded an Incremental Cost‐Effectiveness Ratio (ICER) for pre‐hospital pulse‐oximetry use of $35 (USD) per disability‐adjusted life‐year (DALY) averted compared to no pulse‐oximetry use. One‐way sensitivity analysis showed highest sensitivity to the parameter of downstream hospitalization cost. Given that inpatient management is the standard of care for hypoxemic pneumonia, when only pre‐hospital costs were considered the result was an ICER of $9.9/DALY averted. Both values were considered cost‐effective according to a conservative willingness‐to‐pay (WTP) threshold set for 1x the average GDP per capita in Malawi ($588, 2018). When oxygen was analyzed in combination with pulse‐oximetry, we found a baseline WTP threshold for pre‐hospital oxygen of $71 per patient. For every 1% reduction in total pediatric pneumonia mortality consequent to pre‐hospital oxygen use, we determined the recommended WTP allowance for oxygen would increase by approximately $4.53. Conclusion We conclude that pulse‐oximetry is likely cost‐effective in low‐resource, pre‐hospital environments. We acknowledge the need for further research on the effectiveness of pre‐hospital oxygen in reducing pediatric pneumonia mortality and suggest ranges of cost and efficacy for which oxygen is likely to be found cost‐effective in tandem with pulse‐oximetry. 10.1002/ppul.71095 http://creativecommons.org/licenses/by-nc/4.0/ |
| title | Pre‐Hospital Pulse‐Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost‐Effectiveness Analysis |
| topic | Pediatric Pulmonology |
| url | https://onlinelibrary.wiley.com/doi/10.1002/ppul.71095 |