Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji

Susan Mcallister,Stephen R C Howie,Tim Edmonds,Sainimere Boladuadua,Sainimere Boladuadua,Mireia Gil,Philip C Hill,Eric Rafai,Louise Thorn,Rick Audas

doi:10.1186/s12913-021-06687-8

Abstract

BackgroundOxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide.MethodsData sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars.ResultsCritical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost.ConclusionIntroducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.

Highlights

Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings
Oxygen cylinders are often large, heavy and difficult for staff to move within the facility and potentially hazardous when not attached to wall braces, as is often the case
From the above three issues, critical success factors needed for the assessment of a preferred option of delivery of oxygen in Fiji must include availability, safety, ease of use, feasibility, and affordability

Summary

Introduction

Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Over five million children die globally; a large proportion of these deaths occur in low and middleincome countries (LMICs), and most are preventable [1]. Pneumonia is a leading cause of death in both adults and children [1, 2], and a low level of blood oxygen (hypoxaemia) is a major complication of pneumonia [3]. Hypoxaemia occurs in severe newborn conditions and other illnesses, and in the four leading causes of adult death globally, namely ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive pulmonary disease [6]. Reliable access to medical oxygen is often lacking in LMICs, frequently due to cost and logistical difficulties [3]

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Results

Conclusion