Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings.
Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings.
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在资源匮乏地区诊断先兆子痫的医疗设备的成本效益。
DOI：
10.1016/j.deveng.2017.06.002
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发表时间：
2017
影响因子：
--
通讯作者：
Sienko,KathleenH
中科院分区：
文献类型：
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作者：
McLaren,ZoëM;Sharp,Alana;Hessburg,JohnP;Sarvestani,AmirSabet;Parker,Ethan;Akazili,James;Johnson,TimothyRB;Sienko,KathleenH
孕产妇死亡率仍然是发展中国家面临的一个主要健康挑战，先兆子痫占孕产妇死亡的17%。诊断需要熟练的保健提供者和适合低资源环境的设备。这项研究首次对用于诊断低收入和中等收入国家（LMIC）先兆子痫的多种医疗设备进行了成本效益分析。方法包括从LMIC药典中鉴定的血压和蛋白尿测量装置。我们开发了一个决策树框架，以评估每种器械的成本效益，使用参数值反映基于相关文献和专家意见调查的一般护理标准。我们使用单向和二阶概率多变量分析来检查我们的结果的敏感性。结果由于每种器械避免的残疾调整寿命年（DIFs）非常相似，因此结果受到每次使用成本排名的影响。最具成本效益的设备组合是半自动血压测量设备和目视读取尿试纸测试，最低的组合每次使用成本为0.2004美元，相对于没有诊断设备的基线，每DALY增加93.6美元的增量成本效益比。当获得治疗的机会有限时，改善获得治疗的机会比提高检测率或诊断设备的灵敏度更具成本效益。结论我们的研究结果对设备灵敏度的变化不敏感，但对检测率和治疗率的变化敏感。此外，我们的研究结果表明，简单的设备比复杂的设备更具成本效益。结果强调了两个LMIC设计特点的可取性：易用性和准确性，无需校准。我们的研究结果对政策制定者、卫生经济学家、卫生保健提供者和工程师具有重要意义。
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.