Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
BMJ Glob Health. 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-007168.
Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions.
We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results.
The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya's cost-effectiveness threshold (US$908).
When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.
对有症状的 COVID-19 患者进行病例管理是一项关键的卫生系统干预措施。肯尼亚政府着手填补管理严重和危急 COVID-19 所需的基本和高级重症监护（ACC）方面的能力差距。然而，鉴于资源稀缺，基本和 ACC 方面的差距仍然存在。本研究评估了对基本和 ACC 进行投资的成本效益，以为投资决策的优先排序提供信息。
我们采用决策树模型来评估对基本护理（EC）进行投资与对基本护理和 ACC 进行投资（EC+ACC）的增量成本效益，与肯尼亚当前为 COVID-19 患者提供的医疗保健服务能力（现状）进行比较。我们采用了卫生系统视角，并采用了住院护理时间范围。成本数据来自于初步的实证分析，而结果数据则来自于流行病学模型的估计。我们使用单变量和概率敏感性分析来评估结果的稳健性。
与对 EC 进行投资相比，现状选择在成本和效果方面都较差，因此被后者所主导。对基本和 ACC 进行投资（EC+ACC）的增量成本效益比为每避免一个残疾调整生命年（DALY）需花费 1378.21 美元，因此与肯尼亚的成本效益阈值（908 美元）相比，不是一种具有成本效益的策略。
在考虑成本效益标准的情况下，在资源稀缺的背景下，如果肯尼亚优先考虑对 EC 的投资，而不是对 ACC 的投资，那么它将获得更好的投资回报。然而，这种关于成本效益的信息需要作为多标准决策框架的一部分进行考虑，该框架使用一系列反映肯尼亚社会的社会价值观的标准。
