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Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria.

Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria.

Authors :
Graham HR
Bakare AA
Ayede AI
Eleyinmi J
Olatunde O
Bakare OR
Edunwale B
Neal EFG
Qazi S
McPake B
Peel D
Gray AZ
Duke T
Falade AG
Source :
BMJ global health [BMJ Glob Health] 2022 Aug; Vol. 7 (8).
Publication Year :
2022

Abstract

Introduction: Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme.<br />Methods: Prospective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January-March 2021), summary admission data (January 2018-December 2020), programme cost data.<br />Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support.<br />Primary Outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO <subscript>2</subscript> <90%) children who received oxygen. Comparison across three time periods: preintervention (2014-2015), intervention (2016-2017) and follow-up (2018-2020) using mixed-effects logistic regression. Calculated cost-effectiveness of the intervention on child pneumonia mortality using programme costs, recorded deaths and estimated counterfactual deaths using effectiveness estimates from our effectiveness study. Reported cost-effectiveness over the original 2-year intervention period (2016-2017) and extrapolated over 5 years (2016-2020).<br />Results: Pulse oximetry coverage for neonates and children remained high during follow-up (83% and 81%) compared with full oxygen system period (94% and 92%) and preintervention (3.9% and 2.9%). Oxygen coverage for hypoxaemic neonates/children was similarly high (94%/88%) compared with full oxygen system period (90%/82%). Functional oxygen sources were present in 11/12 (92%) paediatric areas and all (8/8) neonatal areas; three-quarters (15/20) of wards had a functional oximeter. Of 32 concentrators deployed, 23/32 (72%) passed technical testing and usage was high (median 10 797 hours). Estimated 5-year cost-effectiveness US$86 per patient treated, $2694-4382 per life saved and $82-125 per disability-adjusted life year-averted. We identified practical issues for hospitals and Ministries of Health wishing to adapt and scale up pulse oximetry and oxygen.<br />Conclusion: Hospital-level improvements to oxygen and pulse oximetry systems in Nigerian hospitals have been sustained over the medium-term and are a highly cost-effective child pneumonia intervention.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Details

Language :
English
ISSN :
2059-7908
Volume :
7
Issue :
8
Database :
MEDLINE
Journal :
BMJ global health
Publication Type :
Academic Journal
Accession number :
35948344
Full Text :
https://doi.org/10.1136/bmjgh-2022-009278