Pulse-oximetry and supplemental oxygen utilization in low-resource, pre-hospital settings: An exploratory cost-effectiveness analysis

Pneumonia is the leading cause of death globally in children aged 0-5 years. Early access to pulse-oximetry and supplemental oxygen in low-resource, pre-hospital settings may result in improved pediatric pneumonia outcomes. However, few data exist regarding their application in such settings. We performed an exploratory cost-effectiveness analysis using a decision analysis model to examine use of pulse-oximetry and supplemental oxygen in low-resource, pre-hospital settings. Our model yielded an Incremental Cost-Effectiveness Ratio (ICER) for pre-hospital pulse-oximetry use of $229 (USD) per life-year (LY) saved compared to no pulse-oximetry use. Given that inpatient management is the standard of care for hypoxemic pneumonia, when only pre-hospital costs were considered the result was an ICER of $13/LY saved. Both values were considered cost-effective according to a strict willingness-to-pay (WTP) threshold set for the lowest GDP per capita in the world. When oxygen was analyzed in combination with pulse-oximetry, we found a baseline WTP threshold for pre-hospital oxygen of $1.18 per patient. Again, when the payer perspective included only pre-hospital costs, that WTP for oxygen rose to $26.64. For every 1% reduction in total pediatric pneumonia mortality consequent to pre-hospital oxygen use, we determined the recommended WTP allowance for oxygen would increase by approximately $1.75. We conclude that pulse-oximetry is likely cost-effective in low-resource, pre-hospital environments. We acknowledge the need for further research on the effectiveness of pre-hospital oxygen in reducing pediatric pneumonia mortality and suggest ranges of cost and efficacy for which oxygen is likely to be found cost-effective in tandem with pulse-oximetry.