Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review

Kazibwe, Joseph; Shah, Hiral; Kuwawenaruwa, August; Schell, Carl Otto; Khalid, Karima; Tran, Phuong B.; Ghosh, Srobana; Baker, Tim; Guinness, Lorna

doi:10.1136/bmjopen-2021-050881

Cited by 4 publications

(15 citation statements)

References 28 publications

(29 reference statements)

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“… 20 The full methodological protocol used in this review is available elsewhere. 20 For this study, critical care is defined as the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions. 7 It involves enhanced monitoring, treatment and attention required by a patient as a result of the life-threatening aspects of an illness or injury.…”

Section: Methodsmentioning

confidence: 99%

“…A study was considered eligible if it was published in English and reported on the provision of critical care, 20 services offered under critical care, resources and/or costs incurred by the health system or health providers in providing critical care in Tanzania. A detailed inclusion/exclusion criterion can be found in online supplemental 2 .…”

Section: Methodsmentioning

confidence: 99%

“…The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines21 and the protocol was registered with PROSPERO 20. The full methodological protocol used in this review is available elsewhere 20.…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, knowledge on the current availability of resources and the costs of critical care remains sparse. 1 18 19 There is no systematic review that examines the available resources, utilisation and costs of critical care generally 20 nor in LMIC settings.…”

Section: Introductionmentioning

confidence: 99%

“…To inform the planning and scale-up of critical care provision in a low-income country setting, this study takes a systematic approach to review available knowledge on the current resource availability, utilisation and cost in the provision of critical care in Tanzania. 20 …”

Section: Introductionmentioning

confidence: 99%

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Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

et al. 2022

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ObjectivesCritical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania.DesignThis is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMedline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020.Eligibility criteriaWe included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010.Data extraction and synthesisQuality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators.ResultsA total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into: intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania.ConclusionThere is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services.PROSPERO registration numberCRD42020221923.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

et al. 2022

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

Shah¹,

Baker

Schell

et al. 2023

PharmacoEconomics Open

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Background The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ventilators in intensive care units) or more basic critical care such as Essential Emergency and Critical Care (EECC; e.g. vital signs monitoring, oxygen therapy, and intravenous fluids). Methods We investigated the cost effectiveness of providing EECC and advanced critical care in Tanzania in comparison with providing ‘no critical care’ or ‘district hospital-level critical care’ using coronavirus disease 2019 (COVID-19) as a tracer condition. We developed an open-source Markov model ( https://github.com/EECCnetwork/POETIC_CEA ) to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, a 28-day time horizon, patient outcomes obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. We performed a univariate and probabilistic sensitivity analysis to assess the robustness of our results., Results EECC is cost effective 94% and 99% of the time when compared with no critical care (incremental cost-effectiveness ratio [ICER] $37 [−$9 to $790] per DALY averted) and district hospital-level critical care (ICER $14 [−$200 to $263] per DALY averted), respectively, relative to the lowest identified estimate of the willingness-to-pay threshold for Tanzania ($101 per DALY averted). Advanced critical care is cost effective 27% and 40% of the time, when compared with the no critical care or district hospital-level critical care scenarios, respectively. Conclusion For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost effectiveness falls within the range considered ‘highly cost effective’. Further research is needed to explore the potential of EECC to generate even greater benefits and value for money when patients with diagnoses other than COVID-19 are accounted for. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-023-00418-x.

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Hospital readiness for the provision of care to critically ill patients in Tanzania – an in-depth cross-sectional study

Khalid,

Schell,

Oliwa

et al. 2024

Journal of Critical Care

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Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review

Cited by 4 publications

References 28 publications

Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

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

Hospital readiness for the provision of care to critically ill patients in Tanzania – an in-depth cross-sectional study

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