Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

Abstract

Background Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). Methods Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

“…However, in low‐ and middle‐income countries, multiple system‐level barriers exist that impact implementation, evaluation, and sustainability of such approaches. Economic analysis of basic screening devices such as blood pressure monitors and urine dipsticks for use in low‐resource settings has shown that simple devices are most cost‐effective . The more sophisticated tools for first‐trimester screening must be evaluated in this context.…”

Pre-eclampsia: a Scoping Review of Risk Factors and Suggestions for Future Research Direction

“…In low-resource settings in LMICs, blood pressure is likely not measured during routine antenatal visits due to equipment cost and lack of trained personnel [ 85 ]. Researchers have created lower-cost blood pressure monitors for pregnancy, but few of them have been validated for pre-eclampsia diagnosis [ 86 , 87 ].…”

Sample Preparation and Diagnostic Methods for a Variety of Settings: A Comprehensive Review

“…Despite these leaps and bounds in medical technology and diagnostic methodologies, many barriers to standard clinical diagnosis remain, such as physician hesitance to adopt new diagnostic methodologies with small bodies of evidence, slow reimbursement from third-party payers for molecular diagnostic techniques, the need to promptly identify drug-resistant and novel pathogens, the need to diagnose culture-negative infections, the inability to promptly differentiate bacterial and viral respiratory infections, and the need for simple and easy to use testing methods when training technicians [ 24 , 26 , 27 , 59 , 60 ]. In addition to the roadblocks to standard clinical care, further limitations exist for the large variety of resource-limited settings such as low- and middle-income countries (LMICs), the Global South, rural areas, and disaster-stricken regions, including the lack of reliable infrastructure for communication, clean water, and power sources, the tendency for infectious diseases to spread rapidly due to crowding after a natural disaster, lack of access to expensive reagents and devices, lack of trained personnel for complex diagnostic techniques, and increased exposure to disease vectors like insects and livestock [ 25 , 61 , 62 , 63 , 64 ]. Biochemical methods like enzyme-linked immunosorbent assays (ELISA) and molecular diagnostic methods, particularly those utilizing nucleic acid tests (NATs) or nucleic acid amplification tests (NAATs) based on the polymerase chain reaction (PCR) and its many derivatives, have proven to be invaluable in overcoming these obstacles when diagnosing both infectious diseases and non-transmissible conditions in a clinical setting due to their relatively simple operation, quantitative results, molecular-level identification of biomarkers, high sensitivity, and relatively low cost in most cases [ 19 , 24 , 25 , 27 , 28 , 38 , 65 , 66 ].…”