Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis.

Autor:	Resch SC; Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA sresch@hsph.harvard.edu., Suarez S; Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Boston University, Boston, Massachusetts, USA., Omotayo MO; Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Griffin J; Center for Global Health, RTI International, Research Triangle Park, North Carolina, USA., Sessler D; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA., Burke T; Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Oct 05; Vol. 12 (10), pp. e051055. Date of Electronic Publication: 2022 Oct 05.
DOI:	10.1136/bmjopen-2021-051055
Abstrakt:	Objectives: Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries. Setting: Hospitals in Kenyan counties with low rates of caesarean delivery. Participants: Patients needing emergency caesarean delivery in settings without availability of standard anaesthesia service. Interventions: Simulated scales up of the ESM-Ketamine programme over 5 years (2020-24) was compared with status quo. Outcome Measures: Cost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo. Results: Over 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario-a very good value for Kenya at less than 20% of per capita GDP per life-year gained. Conclusion: In areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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