Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji

Abstract

Background Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide. Methods Data sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars. Results Critical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost. Conclusion Introducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.

A Systematic Review on Medical Oxygen Ecosystem: Current State and Recent Advancements

“…The authors found the grid-charged battery-backed concentrator system to be the most effective option, followed by the low-pressure commercial generation and storage system, which is consistent with their previous study. Unlike the comparative studies, McAllister et al presented a study seeking to determine the optimal ratio of oxygen concentrators to medical oxygen cylinders in Fiji [17]. They centered their research on three medical centers and extended it to obtain the cost analysis for all Sub-Divisional Hospitals (SDH) nationwide.…”

“…• High pressure (Ultrox) commercial generation and storage system Financial analysis and planning [17], [18], [19], [20] Structural planning [21], [22] Supply chain modelling and optimization [23], [24], [25], [26], [27], [28] Safety and protection [29], [30], [31], [32]…”

“…Unlike the comparative studies, McAllister et al presented a study seeking to determine the optimal ratio of oxygen concentrators to medical oxygen cylinders in Fiji [17]. They centered their research on three medical centers and extended it to obtain the cost analysis for all Sub-Divisional Hospitals (SDH) nationwide.…”

“…The cryogenic reservoir is attached to a distribution ecosystem that spans the hospital. Universally, cylinders are the standard option of oxygen supply [17].…”

Oxidative Stress and Inflammation in Acute and Chronic Lung Injuries

“…Excessively high levels of O 2 (hyperoxia) can be the result of frequent iatrogenic events leading to additional O 2 supply [ 249 ]. Oxygen therapy is included in the WHO list of essential medicines and is essential in preventing morbidity and mortality in children and adults [ 250 ]. As oxygen therapy is among the most common interventions worldwide, the consequences of hyperoxia should be carefully considered, as prolonged exposure to O 2 in high concentrations is toxic to human health [ 251 ].…”