Evidence map›Paper›PMID 29276756›Full record

ArticleDevelopment engineering2017

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

Zoë M McLaren, Alana Sharp, John P Hessburg, Amir Sabet Sarvestani, Ethan Parker, James Akazili, Timothy R B Johnson, Kathleen H Sienko

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Development engineering, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Zoë M McLarenHealth Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
Alana SharpHealth Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
John P HessburgDepartment of Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125USA.
Amir Sabet SarvestaniDesign Science Program, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125, USA.
Ethan ParkerHealth Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
James AkaziliNavrongo Health Research Centre, Navrongo, Upper East, Ghana.
Timothy R B JohnsonDepartment of Obstetrics & Gynecology, Medical School, University of Michigan, L4000 Womens SPC 5276, Ann Arbor, MI 48109-5276, USA.
Kathleen H SienkoDepartments of Mechanical and Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 3454 GG Brown, Ann Arbor, MI 48109-2125, USA.

Funding

The Ghana-Michigan Post-doctoral And Research Trainee NEtwoRk (PARTNER) ProgramR24TW008814 · FIC · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI ROBINS, THOMAS G · 2010 to 2010
$432k
FIC NIH HHS R24 TW008814
6 · The paper itself

Abstract

backgroundMaternal 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).

methodsBlood 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.

resultsBecause 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.

conclusionsOur 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.

Indexed as

cost-effectiveness analysisglobal healthlow-income and middle-income countrieslow resource settingsmaternal mortalitymedical devicespre-eclampsia

Identifiers

PMID29276756
PMCPMC5737708

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.