Estimated Cost-effectiveness of Solar-Powered Oxygen Delivery for Pneumonia in Young Children in Low-Resource Settings

Abstract

IMPORTANCE Pneumonia is the leading cause of childhood mortality worldwide. Severe pneumonia associated with hypoxemia requires oxygen therapy; however, access remains unreliable in low-and middle-income countries. Solar-powered oxygen delivery (solar-powered O 2 ) has been shown to be a safe and effective technology for delivering medical oxygen. Examining the costeffectiveness of this innovation is critical for guiding implementation in low-resource settings. OBJECTIVETo determine the cost-effectiveness of solar-powered O 2 for treating children in low-resource settings with severe pneumonia who require oxygen therapy. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation study of solar-powered O 2 was conducted from January 12, 2020, to February 27, 2021, in compliance with the World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) guidelines. Using existing literature, plausible ranges for component costs of solar-powered O 2 were determined in order to calculate the expected total cost of implementation. The costs of implementing solarpowered O 2 at a single health facility in low-and middle-income countries was analyzed for pediatric patients younger than 5 years who required supplemental oxygen. EXPOSURES Treatment with solar-powered O 2 . MAIN OUTCOMES AND MEASURES The incremental cost-effectiveness ratio (ICER) of solarpowered O 2 was calculated as the additional cost per disability-adjusted life-year (DALY) saved. Sensitivity of the ICER to uncertainties of input parameters was assessed through univariate and probabilistic sensitivity analyses. RESULTS The ICER of solar-powered O 2 was estimated to be $20 (US dollars) per DALY saved (95% CI, $2.83-$206) relative to the null case (no oxygen). Costs of solar-powered O 2 were alternatively quantified as $26 per patient treated and $542 per life saved. Univariate sensitivity analysis found that the ICER was most sensitive to the volume of pediatric pneumonia admissions and the case fatality rate. The ICER was insensitive to component costs of solar-powered O 2 systems. In secondary analyses, solar-powered O 2 was cost-effective relative to grid-powered concentrators (ICER $140 per DALY saved) and cost-saving relative to fuel generator-powered concentrators (cost saving of $7120). CONCLUSIONS AND RELEVANCE The results of this economic evaluation suggest that solarpowered O 2 is a cost-effective solution for treating hypoxemia in young children in low-and middleincome countries, relative to no oxygen. Future implementation should prioritize sites with high rates (continued) Key Points Question Is solar-powered oxygen delivery (solar-powered O 2 ) a costeffective intervention for use in children younger than 5 years with hypoxemia in low-resource settings? Findings This economic evaluation compared the costs and health outcomes of solar-powered O 2 with (1) null case with no oxygen, (2) gridpowered oxygen concentrators, and (3) fuel generator-powered concentrators. Use of solar-powered O 2 was costeffective relative to the nul...

Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness

“… 25 A modelling analysis conducted by Huang et al estimated the cost-effectiveness of solar-powered oxygen systems over a 10-year period and found a cost-effectiveness estimate of US$20 per DALY averted. 26 The included studies all used facility-based oxygen system solutions based on oxygen concentrators. While this fitted the clinical quality improvement approach of these small to medium-scale programmes, there are opportunities for increased efficiency by larger scale oxygen systems interventions that include a mix of oxygen supply technologies, policy and market shaping activities, and coordinated supply and distribution mechanisms.…”

“…Our cost-effectiveness calculations were also restricted to the study periods (2–3 years), but we would expect these systems to continue working for at least 5 years with proper maintenance 25. A modelling analysis conducted by Huang et al estimated the cost-effectiveness of solar-powered oxygen systems over a 10-year period and found a cost-effectiveness estimate of US$20 per DALY averted 26. The included studies all used facility-based oxygen system solutions based on oxygen concentrators.…”

A Comprehensive Approach to Medical Oxygen Ecosystem Building: An Implementation Case Study in Kenya, Rwanda, and Ethiopia

“…35 A more recent study on a solar-powered oxygen program estimated costs of US$26 per patient treated and US$542 per life saved. 36 These existing estimates provide strong evidence that concentrator systems are cost-effective health interventions. However, while concentrators are well suited to improving oxygen availability in small, rural health care facilities, [36][37][38][39][40] they are not a standalone solution to larger health care facilities, and with most models able to deliver flow rates of 10 L/minute or less, they may not be able to offer the higher levels of flow needed to effectively treat some hypoxemic patients.…”

“…These examples highlight the value-add and importance of considering the entire oxygen ecosystem and align with the findings and conclusions of other organizations implementing oxygen system strengthening solutions. 12,[36][37][38][39][40][41]…”

“… 36 These existing estimates provide strong evidence that concentrator systems are cost-effective health interventions. However, while concentrators are well suited to improving oxygen availability in small, rural health care facilities, 36 – 40 they are not a standalone solution to larger health care facilities, and with most models able to deliver flow rates of 10 L/minute or less, they may not be able to offer the higher levels of flow needed to effectively treat some hypoxemic patients. To the team’s knowledge, this cost-per-patient data is the first available for a large-scale PSA oxygen system.…”