Cost-effectiveness of emergency care interventions in low and middle-income countries: a systematic review.

Kalin Werner,Teri Reynolds,Kenneth Munge,Nicholas Risko,Taylor Burkholder,Lee Wallis

doi:10.2471/blt.19.241158

Abstract

ObjectiveTo systematically review and appraise the quality of cost–effectiveness analyses of emergency care interventions in low- and middle-income countries.MethodsFollowing the PRISMA guidelines, we systematically searched PubMed®, Scopus, EMBASE®, Cochrane Library and Web of Science for studies published before May 2019. Inclusion criteria were: (i) an original cost–effectiveness analysis of emergency care intervention or intervention package, and (ii) the analysis occurred in a low- and middle-income setting. To identify additional primary studies, we hand searched the reference lists of included studies. We used the Consolidated Health Economic Evaluation Reporting Standards guideline to appraise the quality of included studies.ResultsOf the 1674 articles we identified, 35 articles met the inclusion criteria. We identified an additional four studies from the reference lists. We excluded many studies for being deemed costing assessments without an effectiveness analysis. Most included studies were single-intervention analyses. Emergency care interventions evaluated by included studies covered prehospital services, provider training, treatment interventions, emergency diagnostic tools and facilities and packages of care. The reporting quality of the studies varied.ConclusionWe found large gaps in the evidence surrounding the cost–effectiveness of emergency care interventions in low- and middle-income settings. Given the breadth of interventions currently in practice, many interventions remain unassessed, suggesting the need for future research to aid resource allocation decisions. In particular, packages of multiple interventions and system-level changes represent a priority area for future research.

Highlights

where a delay of hours may result in avoidable death or disability
make treatments less effective. Frontline providers deliver these interventions across the emergency care system
from scene care to transport to facilities

Summary

Introduction

Emergency care is a health systems and service delivery innovation that facilitates early recognition and life-saving interventions for time sensitive acute injuries and illnesses, where a delay of hours may result in avoidable death or disability, or make treatments less effective.[1,2] Frontline providers deliver these interventions across the emergency care system, from scene care to transport to facilities. Emergency care is a health systems and service delivery innovation that facilitates early recognition and life-saving interventions for time sensitive acute injuries and illnesses, where a delay of hours may result in avoidable death or disability, or make treatments less effective.[1,2]. Frontline providers deliver these interventions across the emergency care system, from scene care to transport to facilities. Researchers have estimated that over half of deaths in low- and middleincome countries, and up to 2.5 billion disability-adjusted life-years (DALYs) annually, could be addressed through the implementation of effective emergency care.[2] These figures are expected to grow due to factors such as increased use of motor vehicles, increased urbanization and lifestyle changes leading to increases in coronary heart disease.

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Conclusion