Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania

Shah, Hiral; Baker, Tim; Schell, Carl Otto; Kuwawenaruwa, August; Awadh, Khamis; Khalid, Karima; Kairu, Angela; Were, Vincent; Barasa, Edwine; Baker, Peter; Guinness, Lorna

doi:10.1007/s41669-023-00418-x

Cited by 7 publications

(14 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of 31 studies proceeded to quality assessment, of which 13 were excluded due to the presence of very serious limitations ( Table 4 ). Finally, 18 studies of acceptable quality were included in this two-year update ( Carta and Conversano, 2021 ; Congly et al, 2021 ; Ruggeri et al, 2022a ; Ruggeri et al, 2022b ; Dijk et al, 2022 ; Goswami et al, 2022 ; Kelton et al, 2022 ; Lau et al, 2022 ; Metry et al, 2022 ; Park et al, 2022 ; Rafia et al, 2022 ; Savinkina et al, 2022 ; Yeung et al, 2022 ; Alamer et al, 2023 ; Arwah et al, 2023 ; Kowal et al, 2023 ; Ruggeri et al, 2023 ; Shah et al, 2023 ).…”

Section: Resultsmentioning

confidence: 99%

“…Included studies evaluated interventions in community or outpatient settings (5/18) ( Goswami et al, 2022 ; Park et al, 2022 ; Savinkina et al, 2022 ; Yeung et al, 2022 ; Ruggeri et al, 2023 ), where patients are at risk of admission to hospital, or an inpatient hospital setting (11/18) ( Carta and Conversano, 2021 ; Congly et al, 2021 ; Ruggeri et al, 2022a ; Ruggeri et al, 2022b ; Dijk et al, 2022 ; Kelton et al, 2022 ; Lau et al, 2022 ; Rafia et al, 2022 ; Alamer et al, 2023 ; Kowal et al, 2023 ; Shah et al, 2023 ); one study included both settings (1/18) ( Metry et al, 2022 ). One study evaluated point-of-care tests in an unspecified health facility (1/18) ( Arwah et al, 2023 ).…”

Section: Resultsmentioning

confidence: 99%

“…One study evaluated point-of-care tests in an unspecified health facility (1/18) ( Arwah et al, 2023 ). Of studies based in inpatient hospital settings, some were aimed at specific populations and places within the care pathway, namely moderate disease with non-invasive ventilation (3/12) ( Ruggeri et al, 2022a ; Ruggeri et al, 2022b ; Rafia et al, 2022 ) or critical care (1/12) ( Shah et al, 2023 ), though most had mixed or unspecified populations (8/12) ( Carta and Conversano, 2021 ; Congly et al, 2021 ; Dijk et al, 2022 ; Kelton et al, 2022 ; Lau et al, 2022 ; Metry et al, 2022 ; Alamer et al, 2023 ; Kowal et al, 2023 ). Most studies (12/18) ( Carta and Conversano, 2021 ; Congly et al, 2021 ; Dijk et al, 2022 ; Goswami et al, 2022 ; Lau et al, 2022 ; Metry et al, 2022 ; Rafia et al, 2022 ; Savinkina et al, 2022 ; Yeung et al, 2022 ; Alamer et al, 2023 ; Kowal et al, 2023 ; Ruggeri et al, 2023 ) took a healthcare system or payer perspective in their base-case analyses, while 2/18 took a provider (e.g., hospital) perspective ( Ruggeri et al, 2022a ; Shah et al, 2023 ), 2/18 took a partial societal perspective ( Kelton et al, 2022 ; Arwah et al, 2023 ), and 2/18 did not explicitly report a perspective ( Ruggeri et al, 2022b ; Park et al, 2022 ).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostics and treatments of COVID-19: two-year update to a living systematic review of economic evaluations

Elvidge,

Hopkin,

Narayanan

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Objectives: As the initial crisis of the COVID-19 pandemic recedes, healthcare decision makers are likely to want to make rational evidence-guided choices between the many interventions now available. We sought to update a systematic review to provide an up-to-date summary of the cost-effectiveness evidence regarding tests for SARS-CoV-2 and treatments for COVID-19.Methods: Key databases, including MEDLINE, EconLit and Embase, were searched on 3 July 2023, 2 years on from the first iteration of this review in July 2021. We also examined health technology assessment (HTA) reports and the citations of included studies and reviews. Peer-reviewed studies reporting full health economic evaluations of tests or treatments in English were included. Studies were quality assessed using an established checklist, and those with very serious limitations were excluded. Data from included studies were extracted into predefined tables.Results: The database search identified 8,287 unique records, of which 54 full texts were reviewed, 28 proceeded for quality assessment, and 15 were included. Three further studies were included through HTA sources and citation checking. Of the 18 studies ultimately included, 17 evaluated treatments including corticosteroids, antivirals and immunotherapies. In most studies, the comparator was standard care. Two studies in lower-income settings evaluated the cost effectiveness of rapid antigen tests and critical care provision. There were 17 modelling analyses and 1 trial-based evaluation.Conclusion: A large number of economic evaluations of interventions for COVID-19 have been published since July 2021. Their findings can help decision makers to prioritise between competing interventions, such as the repurposed antivirals and immunotherapies now available to treat COVID-19. However, some evidence gaps remain present, including head-to-head analyses, disease-specific utility values, and consideration of different disease variants.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021272219], identifier [PROSPERO 2021 CRD42021272219].

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostics and treatments of COVID-19: two-year update to a living systematic review of economic evaluations

Elvidge,

Hopkin,

Narayanan

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…For critically unwell patients, open and functional interdepartmental linkages and communication systems are vital owing to the time-critical nature of their conditions, and the fact that they often cannot advocate for themselves. If the turn-around-time is to be reduced, it is, therefore, essential to eliminate these administrative stumbling blocks, to reduce the congestion in the emergency care pathways, and capitalise on the cost-effectiveness of the basic emergency care interventions 44–47…”

Section: Discussionmentioning

confidence: 99%

Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya

Onyango,

Willows,

McKnight

et al. 2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

ObjectivesThird delay refers to delays in delivering requisite care to patients after they arrive at a health facility. In low-resource care settings, effective triage and flow of care are difficult to guarantee. In this study, we aimed to identify delays in the delivery of care to critically ill patients and possible ways to address these delays.DesignThis was an exploratory qualitative study using in-depth interviews and patient journeys. The qualitative data were transcribed and aggregated into themes in NVivo V.12 Plus using inductive and deductive approaches.SettingThis study was conducted in four secondary-level public Kenyan hospitals across four counties between March and December 2021. The selected hospitals were part of the Clinical Information Network.ParticipantsPurposive sampling method was used to identify administrative and front-line healthcare providers and patients. We conducted 12 in-depth interviews with 11 healthcare workers and patient journeys of 7 patients. Informed consent was sought from the participants and maintained throughout the study.ResultsWe identified a cycle of suboptimal systems for care with adaptive mechanisms that prevent quality care to critically ill patients. We identified suboptimal systems for identification of critical illness, inadequate resources for continuity care and disruption of the flow of care, as the major causes of delays in identification and the initiation of essential care to critically ill patients. Our study also illuminated the contribution of inflexible bureaucratic non-clinical business-related organisational processes to third delay.ConclusionEliminating or reducing delays after patients arrive at the hospital is a time-sensitive measure that could improve the care outcomes of critically ill patients. This is achievable through an essential emergency and critical care package within the hospitals. Our findings can help emphasise the need for standardised effective and reliable care priorities to maintain of care of critically ill patients.

show abstract

“…26 In Tanzania, preliminary analysis has found that the probability of EECC provision being cost-effective is greater than 95% while more advanced critical care is not cost-effective based on commonly used thresholds. [26][27][28][29] While these estimates provide a good benchmark, they have limitations; observational studies on the clinical effectiveness of EECC are not yet available. However, a focus on delivering quality EECC at scale would also promote equity, making it a priority for inclusion in universal health coverage strategies.…”

Section: Summary Boxunclassified

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

English,

Oliwa,

Khalid

et al. 2023

BMJ Glob Health

Self Cite

View full text Add to dashboard Cite

Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals’ ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients’ care and their transitions and not be focused on a single location providing ‘critical care’. We propose a five-part strategy to support the system changes needed.

show abstract

Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania

Cited by 7 publications

References 63 publications

Diagnostics and treatments of COVID-19: two-year update to a living systematic review of economic evaluations

Diagnostics and treatments of COVID-19: two-year update to a living systematic review of economic evaluations

Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

Contact Info

Product

Resources

About