Haghparast-Bidgoli Hassan, Hull-Bailey Tim, Nkhoma Deliwe, Chiyaka Tarisai, Wilson Emma, Fitzgerald Felicity, Chimhini Gwendoline, Khan Nushrat, Gannon Hannah, Batura Rekha, Cortina-Borja Mario, Larsson Leyla, Chiume Msandeni, Sassoon Yali, Chimhuya Simbarashe, Heys Michelle
Institute for Global Health, University College London, London, United Kingdom.
Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
JMIR Mhealth Uhealth. 2023 Dec 22;11:e50467. doi: 10.2196/50467.
Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap.
We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe.
We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented.
Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50).
Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.
2020年出生的240万新生儿中有三分之二在出生后的头28天内死亡，若对所有患病和体重过轻的新生儿实施现有的低成本循证干预措施，这些死亡本可避免。一种将数据采集与教育及临床决策支持相结合的开源数字质量改进工具（Neotree）有望填补这一实施差距。
我们展示了在马拉维和津巴布韦的3家医院对Neotree进行试点实施的成本分析结果。
我们结合基于活动的成本核算和支出方法，估算了在马拉维的1家医院——卡穆祖中央医院（KCH）以及津巴布韦的2家医院——萨利·穆加贝中央医院（SMCH）和奇诺伊省医院（CPH）开展Neotree试点的开发和实施成本。我们从提供者的角度估算了12个月内的成本。通过支出报告、每月员工时间使用情况调查和项目员工访谈收集数据。进行了敏感性分析和情景分析，以评估不确定性对结果的影响或估算大规模实施时的潜在成本。在KCH和一家未实施Neotree的可比医院进行了试点时间动作调查。
在KCH、SMCH和CPH实施Neotree试点的总成本分别为37,748美元、52,331美元和41,764美元。每名入院儿童的平均每月成本分别为15美元、15美元和58美元。员工成本是主要成本组成部分（平均占总成本的73%，范围为63%至79%）。敏感性分析结果表明入院人数的不确定性对所有医院的成本都有重大影响。在马拉维，用服务器取代每月的网络托管服务对成本也有重大影响。在常规（非研究）条件下且大规模实施时，总成本预计将大幅下降，降幅高达76%，使KCH每名入院儿童的成本降至低至5美元，SMCH降至4美元，CPH降至14美元。使用Neotree（n = 250）时，收治一名婴儿的中位时间为27（四分位间距20 - 40）分钟，而使用纸质系统（n = 34）时为26（四分位间距21 - 30）分钟；使用Neotree（n = 246）时，让一名婴儿出院的中位时间为9（四分位间距7 - 13）分钟，而使用纸质系统（n = 50）时为3（四分位间距2 - 4）分钟。
Neotree是一种节省时间和成本的工具，与低收入和中等收入国家有限的类似移动健康决策支持工具的结果相当。Neotree在不同医院的实施成本差异很大，主要是由于医院规模不同。由于整合到卫生系统以及人员和间接费用等成本项目的降低带来的规模经济，大规模实施时实施成本可大幅降低。需要更多研究来评估大规模移动健康决策支持工具的影响和成本效益。
