Guinness Lorna, Kairu Angela, Kuwawenaruwa August, Khalid Karima, Awadh Khamis, Were Vincent, Barasa Edwine, Shah Hiral, Baker Peter, Schell Carl Otto, Baker Tim
Center for Global Development, Great Peter House, Abbey Gardens, Great College St, London, SW1P 3SE, UK.
Global Health Economics Centre, London School of Hygiene and Tropical Medicine, London, UK.
Cost Eff Resour Alloc. 2023 Feb 13;21(1):15. doi: 10.1186/s12962-023-00425-z.
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020.The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively.EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited.
基本急诊与重症护理（EECC）是一种针对重症患者护理的全新方法，专注于一线、有效、低成本的救命护理，且设计得即使在资源匮乏和人员不足的环境中也可行。这与通常在配备专业人员、设施和技术的重症监护病房进行的高级重症护理不同。本文估算了EECC和高级重症护理在坦桑尼亚和肯尼亚为重症患者规划护理时的增量成本。增量成本核算采用了卫生系统视角。使用了一种基于通过最近发布的关于EECC的全球共识所定义的要素的规范方法。研究场景是一家 district hospital（此处原文有误，推测应为“地区医院”），在该医院为患者提供该级别通常针对其病情的确定性护理。资源使用的量化以新冠疫情作为追踪情况，借助临床专业知识。在有可用数据的地方使用当地价格，并将所有成本换算为2020年美元。对于中度、重度和危重症新冠患者，EECC的人均每日成本在坦桑尼亚估计分别为1美元、11美元和33美元，在肯尼亚分别为2美元、14美元和37美元。对于重度和危重症新冠患者，高级重症护理的人均每日成本在坦桑尼亚估计为13美元和294美元，在肯尼亚分别为17美元和345美元。EECC是为所有重症患者提供基本护理的全新方法。提供EECC所固有的低成本和低技术方法意味着可以为许多患者提供EECC，这表明在资源有限时，将EECC置于高级重症护理之上可能是一种合理的方法。
