A Nighttime Telemedicine and Medication Delivery Service to Avert Pediatric Emergencies in Haiti: An Exploratory Cost-Effectiveness Analysis

Katelyn E Flaherty, Molly B Klarman, Youseline Cajusma, Justin Schon, Lerby Exantus, Valery M Beau de Rochars, Chantale Baril, Torben K Becker, Eric J Nelson, Katelyn E Flaherty, Molly B Klarman, Youseline Cajusma, Justin Schon, Lerby Exantus, Valery M Beau de Rochars, Chantale Baril, Torben K Becker, Eric J Nelson

Abstract

We sought to compare the costs of a nighttime pediatric telemedicine and medication delivery service per disability-adjusted life year (DALY) averted to the costs of current hospital emergency care per DALY averted from a societal perspective. We studied a nighttime pediatric telemedicine and medication delivery service and hospital emergency care in a semi-urban and rural region of Haiti. Costs of the two services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the "years lives lost" and "years lost to disability" from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from 0 to 9 years old. The incremental cost-effectiveness ratio was estimated and compared with the per capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an incremental cost-effectiveness less than three times the per capita GDP of Haiti ($3,531). The total costs of the nighttime telemedicine and medication delivery service and hospital emergency care to society were $317,898 per year and $89,392 per year, respectively. The DALYs averted by the service and hospital emergency care were 199.76 and 22.37, respectively. Correspondingly, the incremental cost-effectiveness ratio is estimated at $1,288 signifying the service costs an additional $1,288 to avert one additional DALY. A scaled nighttime pediatric telemedicine and medication delivery service is likely a cost-effective alternative to hospital emergency care for preemergency pediatric conditions in Haiti, and possibly in similar lower-middle-income countries.

Figures

Figure 1.
Figure 1.
Scaled MotoMeds workflow. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Costs and effects of MotoMeds telemedicine and medication delivery service. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
Costs and effects of hospital emergency care. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Sensitivity analysis. Univariate sensitivity analysis was performed to evaluate how uncertainty of individual parameter estimates affected the Incremental Cost Effectiveness Ratio in relation to the per capita GDP in Haiti. The vertical orange line designates the per capita GDP of Haiti ($1,177). Two times the per capita GDP is $2,354. Three times the per capita GDP is $3,531 (the cost-effectiveness threshold). This figure appears in color at www.ajtmh.org.

References

    1. GBD 2019 Viewpoint Collaborators , 2020. Five insights from the Global Burden of Disease Study 2019. Lancet 396: 1135–1159.
    1. Grief SN , 2013. Upper respiratory infections. Prim Care 40: 757–770.
    1. Brandt KG Castro Antunes MM Silva GA , 2015. Acute diarrhea: evidence-based management. J Pediatr (Rio J) 91: S36–S43.
    1. Bhutta ZA Das JK Walker N Rizvi A Campbell H Rudan I Black RE , 2013. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 381: 1417–1429.
    1. Munos MK Walker CLF Black RE , 2010. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol 39 (Suppl 1): i75–i87.
    1. Walker CLF Black RE , 2010. Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes. Int J Epidemiol 39 ( Suppl 1 ): i63–i69.
    1. Geurts D Steyerberg EW Moll H Oostenbrink R , 2017. How to predict oral rehydration failure in children with gastroenteritis. J Pediatr Gastroenterol Nutr 65: 503–508.
    1. Tansley G Schuurman N Amram O Yanchar N , 2015. Spatial access to emergency services in low- and middle-income countries: a GIS-based analysis. PLOS ONE 10: e0141113.
    1. Caires AL , 2017. Mobile health care for people who are homeless. Creat Nurs 23: 151–157.
    1. United Nations Interagency Group for Child Mortality Estimation , 2019. Levels and Trends in Child Mortality. New York, NY: United Nations Children’s Fund.
    1. Gage AD Leslie HH Bitton A Jerome JG Thermidor R Joseph JP Kruk ME , 2017. Assessing the quality of primary care in Haiti. Bull World Health Organ 95: 182–190.
    1. Clark H et al. 2020. A future for the world’s children? A WHO-UNICEF-Lancet Commission. Lancet 395: 605–658.
    1. World Health Organization, 2021. Global Health Expenditure Database. Available at: . Accessed July 23, 2021.
    1. Cavagnero EDV Cros MJ Dunworth AJ Sjoblom MC , 2017. Better Spending, Better Care: A Look at Haiti's Health Financing: Summary Report (English). Washington, DC: The World Bank Group.
    1. United Nations Interagency Group for Child Mortality Estimation , 2019. Levels and Trends in Child Mortality. New York, NY: United Nations Children’s Fund.
    1. Vinekar K et al. 2015. Hospitalizations and deaths because of respiratory and diarrheal diseases among Haitian children under five years of age, 2011–2013. Pediatr Infect Dis J 34: e238–e243.
    1. United Nations Development Programme , 2020. Sustainable Development Goals. Available at: . Accessed March 20, 2020.
    1. NCD Countdown 2030 Collaborators , 2020. NCD countdown 2030: pathways to achieving sustainable development goal target 3.4. Lancet 396: 918–934.
    1. Lozano R et al. 2018. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392: 2091–2138.
    1. The World Health Organization , 2017. Tracking Universal Health Coverage: 2017 Global Monitoring Report. Washington, DC: The World Bank.
    1. Klarman M Schon J Cajusma Y Maples S Beau de Rochars VEM Baril C Nelson EJ , 2021. Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti. BMJ Open 11: e047367.
    1. World Health Organization , 2020. Integrated Management of Childhood Illness. Geneva, Switzerland: WHO.
    1. World Health Organization , 2019. Exploratory Meeting to Review New Evidence for Integrated Management of Childhood Illness (IMCI) Danger Signs. Geneva, Switzerland: WHO.
    1. Tan-Torres Edejer T Baltussen R Adam T , 2003. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva, Switzerland: World Health Organization.
    1. Macrotrends, 2022. Haiti GDP per Capita. Available at: . Accessed July 20, 2021.
    1. Direction Des Statistiques Démographiques Et Sociales , 2015. Population Totale, De 18 Ans Et Plus. Menages Et Densities Estimes En 2015. Available at: . Accessed May 15, 2021.
    1. ESRI , 2019. ArcGIS. Redlands, CA: Environmental Systems Research Institute.
    1. Open Street Map Contributors , 2021. Open Street Map. Available at: . Accessed June 28, 2021.
    1. The World Bank , 2019. Total Population. Available at: . Accessed June 1, 2021.
    1. Institut Haïtien de l'Enfance IHEH, Icf , 2018. Haiti Enquête Mortalité, Morbidité et Utilisation des Services 2016-2017. Available at: . Accessed May 5, 2021.
    1. Banque de la Republique d’Haïti, 2021. Taux de Change. Available at: . Accessed July 1, 2021.
    1. Twilio, 2021. Twilio Customer Engagement Platform. Available at: . Accessed June 20, 2021.
    1. Trekmedics, 2021. Beacon. Available at: . Accessed August 1, 2021.
    1. GBD 2019 Demographics Collaborators , 2020. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 396: 1160–1203.
    1. Baral R Nonvignon J Debellut F Agyemang SA Clark A Pecenka C , 2020. Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates. BMC Public Health 20: 619.
    1. Macrotrends, 2022. Haiti Life Expectancy 1950--2021. Available at: . Accessed August 1, 2021.
    1. Haacker M Hallett TB Atun R , 2020. On discount rates for economic evaluations in global health. Health Policy Plan 35: 107–114.
    1. Woods B Revill P Sculpher M Claxton K , 2016. Country-level cost-effectiveness thresholds: initial estimates and the need for further research. Value Health 19: 929–935.
    1. R Core Team , 2020. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.
    1. Macrotrends, 2019. Haiti GNI per Capita. Available at: . Accessed August 2, 2021.
    1. Wootton R , 2008. Telemedicine support for the developing world. J Telemed Telecare 14: 109–114.
    1. Wang YY Apolzan J Perrin C Woods T Alam M Banwell C Olsen A Lokuge K , 2019. Patients’ and doctors’ perceptions of a mobile phone–based consultation service for maternal, neonatal, and infant health care in Bangladesh: a mixed-methods study. JMIR Mhealth Uhealth 7: e11842.
    1. Karari C Tittle R Penner J Kulzer J Bukusi EA Marima R Cohen CR , 2011. Evaluating the uptake, acceptability, and effectiveness of Uliza! Clinicians’ HIV hotline: a telephone consultation service in Kenya. Telemed J E Health 17: 420–426.

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