Cost–effectiveness of emergency care interventions in low and middle-income countries: a systematic review

Werner, Kalin; Risko, Nicholas; Burkholder, Taylor; Munge, Kenneth; Wallis, Lynne; Reynolds, Teri

doi:10.2471/blt.19.241158

Cited by 33 publications

(49 citation statements)

References 50 publications

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“…There is a mounting body of evidence demonstrating the impact of emergency care in LMICs [ 9 , 10 ]; however, not enough is known about the cost and resources required to achieve these gains. The existing body of cost-effectiveness literature is methodologically weak, often failing to use empirically derived local inputs, and focused on analysing single-intervention rather than the cost-effectiveness of system changes and process improvements [ 11 ]. Electronic medical records, digital billing systems, and dedicated emergency unit budgets available in high-income settings have supported efforts to evaluate the costs for many EC interventions in these settings [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Werner

Lin

Risko

et al. 2021

BMC Health Serv Res

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Background Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions. Methods A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions. Results Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05). Conclusion This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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Section: Introductionmentioning

confidence: 99%

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Werner

Lin

Risko

et al. 2021

BMC Health Serv Res

Self Cite

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“…29 Based on this standard, thrombolytics for acute stroke treatment are not a cost-effective investment, at least for low-income countries. 30 Moreover, an increase in indirect cost should be accounted for given the tradeoff between improving life expectancy and potentially increasing morbidity.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017

Khan

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged 44 years), midlife (aged 45-64 years), and older (aged !65 years) adults. Patients and Methods: We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017 to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes. Results: Of 11,381,390 strokes, 79% (n¼9,009,007) were ischemic and 21% (n¼2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke. Conclusion: Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.

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“…EPs are paid well (around 4.5-5 lakh Indian currency per month) in Arab countries; as per Western literature, EPs enjoy several financial advantages. [ 9 10 11 12 ] In the 2018 Medscape Physician Compensation Report, EM was ranked 13th of 29 specialities, with an average income of $350,000/annual. EPs generally earn a total compensation of more than $200 per hour and sometimes more than $300 per hour.…”

Section: Global Appeal and Economical/financial Aspects Of Emmentioning

confidence: 99%

Emergency medicine – A great career field for the anaesthesiologist!

Ramesh

Mehdiratta²,

Parimal

et al. 2021

Indian J Anaesth

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Emergency Medicine (EM) is a fast upcoming medical speciality wherein patients presenting with emergent life-saving medical and surgical problems are managed. Emergency physicians are first-line providers of emergency care. They diagnose important clinical conditions even before completing patient assessment, order investigations, interventions, resuscitation and treatment for life-threatening acute conditions. There are several interesting sub-specialisations of EM like trauma care, disaster medicine, toxicology, ultrasonography, critical care medicine, hyperbaric medicine, etc. In some countries, the speciality of EM is a popular choice among medical students; whereas in some other countries, the speciality is now evolving. In India, the speciality is growing fast; Nonetheless, the National Medical Commission has made the existence of the department of EM compulsory in all medical colleges in India from the session of 2022-23. Anaesthesiologists suit the speciality of EM because they have quick decision making skills and swift reflexes as well as diverse knowledge and skills in the fields of critical care, resuscitation and pain management. This article written by anaesthesiologists working in the field of EM, attempts to guide the postgraduate students wanting to take up a career in EM.

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Cost–effectiveness of emergency care interventions in low and middle-income countries: a systematic review

Cited by 33 publications

References 50 publications

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017

Emergency medicine – A great career field for the anaesthesiologist!

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