ArticleAnnals of global health2020
Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis.
Article in Annals of global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review of methodological approaches in economic evaluations of maternal and neonatal sepsis interventions in low- and middle-income countries.BMC health services research · 2025Pooled it
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
- Antimicrobial Resistance in Sub-Saharan Africa: A Comprehensive Landscape Review.The American journal of tropical medicine and hygiene · 2025Review
- EPidemiology, clinical characteristics and Outcomes of 4546 adult admissions to high-dependency and intensive care units in Kenya (EPOK): a multicentre registry-based observational study.Critical care explorations · 2024Article
- Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone-a registry based evaluation.BMC pregnancy and childbirth · 2023Article
- A health systems approach to critical care delivery in low-resource settings: a narrative review.Intensive care medicine · 2023Review
- Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia.Risk management and healthcare policy · 2021Article
- Malaria and COVID-19: Common and Different Findings.Tropical medicine and infectious disease · 2020Article
- The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana.PloS one · 2020Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life-saving critical care interventions in low-resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource-poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective: To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods: The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings: 523 patients (median age 25 years, IQR 21-30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 - resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion: With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.
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