Zoë M. McLaren , Alana Sharp , John P. Hessburg , Amir Sabet Sarvestani , Ethan Parker , James Akazili , Timothy R.B. Johnson , Kathleen H. Sienko
{"title":"医疗设备在低资源环境下诊断先兆子痫的成本效益","authors":"Zoë M. McLaren , Alana Sharp , John P. Hessburg , Amir Sabet Sarvestani , Ethan Parker , James Akazili , Timothy R.B. Johnson , Kathleen H. Sienko","doi":"10.1016/j.deveng.2017.06.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% 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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37901,"journal":{"name":"Development Engineering","volume":"2 ","pages":"Pages 99-106"},"PeriodicalIF":0.0000,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.deveng.2017.06.002","citationCount":"15","resultStr":"{\"title\":\"Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings\",\"authors\":\"Zoë M. McLaren , Alana Sharp , John P. Hessburg , Amir Sabet Sarvestani , Ethan Parker , James Akazili , Timothy R.B. Johnson , Kathleen H. Sienko\",\"doi\":\"10.1016/j.deveng.2017.06.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% 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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":37901,\"journal\":{\"name\":\"Development Engineering\",\"volume\":\"2 \",\"pages\":\"Pages 99-106\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.deveng.2017.06.002\",\"citationCount\":\"15\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Development Engineering\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352728515300816\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Economics, Econometrics and Finance\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Development Engineering","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352728515300816","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Economics, Econometrics and Finance","Score":null,"Total":0}
Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings
Background
Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% 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.
Development EngineeringEconomics, Econometrics and Finance-Economics, Econometrics and Finance (all)
CiteScore
4.90
自引率
0.00%
发文量
11
审稿时长
31 weeks
期刊介绍：
Development Engineering: The Journal of Engineering in Economic Development (Dev Eng) is an open access, interdisciplinary journal applying engineering and economic research to the problems of poverty. Published studies must present novel research motivated by a specific global development problem. The journal serves as a bridge between engineers, economists, and other scientists involved in research on human, social, and economic development. Specific topics include: • Engineering research in response to unique constraints imposed by poverty. • Assessment of pro-poor technology solutions, including field performance, consumer adoption, and end-user impacts. • Novel technologies or tools for measuring behavioral, economic, and social outcomes in low-resource settings. • Hypothesis-generating research that explores technology markets and the role of innovation in economic development. • Lessons from the field, especially null results from field trials and technical failure analyses. • Rigorous analysis of existing development "solutions" through an engineering or economic lens. Although the journal focuses on quantitative, scientific approaches, it is intended to be suitable for a wider audience of development practitioners and policy makers, with evidence that can be used to improve decision-making. It also will be useful for engineering and applied economics faculty who conduct research or teach in "technology for development."
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
