Evaluating the cost-effectiveness of pulse oximetry during surgery in low-income countries

West MidlandsCardiovascular
Published Date: 1 Nov 2015

Evaluating the cost-effectiveness of pulse oximetry during surgery in low-income countries

Background

  • A pulse oximeter monitors oxygen saturation and pulsation during surgery, and can provide early warning of hypoxia, hypovolaemia and impending cardiac arrest.
  • Routine use is recommended for all patients undergoing anaesthesia.
  • However, pulse oximetry is unavailable in many operating theatres in low-income countries (LICs) – partly because of the high purchase cost.
  • The Lifebox® oximetry project provides a lowcost, hand-held pulse oximeter.
  • However, as this is still a considerable investment for resource-constrained settings, a cost-effectiveness analysis is needed for patients undergoing surgery in LICs.

Findings

  • The Lifebox® hand -held oximeter performs as well as standard tabletop oximeters
  • Total peri -operative mortality was 2,445 deaths per million procedures in LICs, and 467 deaths per million were potentially preventable by oximetry.
  • Estimated that 10% of anaesthetic -related deaths could be averted by oximetry.
  • 15.5 DALYs (disability adjusted life years) are averted per anaesthetic -related deaths avoided.
  • Costs per DALY averted were US$115 for the hand -held oximeter, and US$374 for the tabletop pulse oximeter, and fell below the very cost -effectiveness threshold of one times the GDP per capita for low -income countries.
  • Purchasing hand -held oximeters for the 77,000 operating theatres around the world without oximeters would cost US$19.3 million and would reduce the global burden of disease by an estimated 63,800 DALYs annually.
  • Sensitivity analysis suggests the hand -held pulse oximeter would be very cost -effective even if it prevented only 1.7% of anaesthetic -related deaths, or 0.3% of total peri -operative deaths. This could increase if non -fatal brain damage was also taken into account.
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