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Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis
Stephen Charles Resch1, Sebastian Suarez2,3, Moshood Olanrewaju Omotayo2,4
1Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA sresch@hsph.harvard.edu.
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.
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