A nighttime telemedicine and medication delivery service to avert pediatric emergencies: An exploratory cost-effectiveness analysis

Abstract

ABSTRACTObjectiveWe sought to compare the costs of a nighttime pre-emergency pediatric telemedicine and medication delivery service (TMDS) per disability-adjusted life year (DALY) averted to the costs of hospital emergency medicine (HEM) per DALY averted from a societal perspective.MethodsWe studied a nighttime pediatric TMDS and HEM in a semi-urban and rural region of Haiti. Costs of the 2 services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the ‘years lives lost’ (YLL) and ‘years lost to disability’ (YLD) from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from zero to 9 years old. The incremental cost-effectiveness ratio (ICER) was estimated and compared to the per-capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an ICER less than 3 times the per-capita GDP of Haiti ($3,531). Univariate sensitivity analysis was performed to evaluate how uncertainty of individual parameter estimates (utilization rates, costs, lost wages, discounting factor) affected the ICER.ResultsThe total costs of the nighttime TMDS and HEM to society were $285,931.72 per year and $89,335.41 per year, respectively. The DALYs averted by the TMDS and HEM were 199.76 and 22.37, respectively. Through sensitivity analyses, the ICER of the TMDS ranged from $791.43 to $1,593.35.ConclusionA nighttime pediatric TMDS is a cost-effective alternative to HEM for pre-emergency pediatric care in semi-urban and rural regions in Haiti, and possibly in similar lower-middle income countries.