{"paper_id":"18a8577c-9583-45da-8639-dc12cea91aa8","body_text":"Cost-Effectiveness Analysis of Inventory Levels in Rural Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-Effectiveness Analysis of Inventory Levels in Rural Ethiopia peter ellison, Bezawit Demissie, Solomon Muktar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8946990/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objectives To estimate the cost-effectiveness of investing in higher pneumonia drug inventory levels to prevent treatment stockouts in rural Ethiopian health facilities. Methods A cost-effectiveness analysis was conducted using facility inventory data from five health centers. Drug availability, measured as days in stock (DIS), was modelled from current 80% to 99% DIS. Incremental costs included procurement, transport, and increased storage costs. Health outcomes were derived from expected reductions in missed pneumonia treatments. Results were expressed as incremental cost-effectiveness ratios (ICERs) per life saved and per life-year gained. Results Increasing inventory from 80% to 99% DIS increased annual treatment capacity from 4,757 to 5,887 patients, saving an estimated 28 additional lives at an ICER of $ 18 per life saved under mid-range assumptions. Worst-case estimates showed an ICER of $ 636 per life saved. Even in the worst scenario, the cost per life-year gained was highly cost-effective at 2% of GDP per capita. Conclusions Investment in drug inventory to reduce pneumonia treatment stockouts is a highly cost-effective approach to improving child survival and warrants further policy attention in resource-limited settings. Full Text Additional Declarations No competing interests reported. Supplementary Files Appendix1SupplyChainCalculations.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 24 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviews received at journal 27 Feb, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers invited by journal 27 Feb, 2026 Editor invited by journal 26 Feb, 2026 Editor assigned by journal 25 Feb, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8946990\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":600137838,\"identity\":\"d0faa155-3b7e-4e9d-a373-104a56a259b2\",\"order_by\":0,\"name\":\"peter ellison\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Supply Chain Specialist\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"peter\",\"middleName\":\"\",\"lastName\":\"ellison\",\"suffix\":\"\"},{\"id\":600137840,\"identity\":\"2682668a-9e13-48eb-9cbc-cfc17ccb6127\",\"order_by\":1,\"name\":\"Bezawit Demissie\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYBACAySSgYGxwQbC4CGsxQCmJQ2hBZc2AxSKseEwYS3m7O0PP/MU/AExLn78ueO8PP+MBMYHb9sY5OxxaLHsOZAszQN0mGXPmWJp3jO3DWfcSGA2nNvGYIzTYTcSDkjnALUY3MhJkGZsu83YcCOBTZq3jSGxB5eW+w+bf4O13H+T/PNn2zn7+TcS2H8DtdTj1HKDmQ1qC/sxCd62A4kbgLYwA7Uk4HKYZU8am/UfA2MegzM5bNa8bcnJG888bJacc07CsOcArhA7/vjmjD9ycgbHgYyfbXa2844nH/zwpsxGnr0BhzVQAHQFDyINAAkJ/OohgP0BMapGwSgYBaNgBAIAjypZcCwj8wgAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Addis Ababa University Addis Ababa, Ethiopia\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Bezawit\",\"middleName\":\"\",\"lastName\":\"Demissie\",\"suffix\":\"\"},{\"id\":600137842,\"identity\":\"5a9b2a9e-1aa0-4beb-812d-0d14eeee4d72\",\"order_by\":2,\"name\":\"Solomon Muktar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ministry of Health - 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Drug availability, measured as days in stock (DIS), was modelled from current 80% to 99% DIS. Incremental costs included procurement, transport, and increased storage costs. Health outcomes were derived from expected reductions in missed pneumonia treatments. Results were expressed as incremental cost-effectiveness ratios (ICERs) per life saved and per life-year gained.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eIncreasing inventory from 80% to 99% DIS increased annual treatment capacity from 4,757 to 5,887 patients, saving an estimated 28 additional lives at an ICER of \\u003cspan\\u003e$\\u003c/span\\u003e18 per life saved under mid-range assumptions. Worst-case estimates showed an ICER of \\u003cspan\\u003e$\\u003c/span\\u003e636 per life saved. 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