PDF(Pubmed)
Abstract：
Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap.
We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe.
We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented.
Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50).
Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.
We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe.
We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented.
Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50).
Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.
摘要：
在2020年出生后的头28天内发生的240万新生儿死亡中，有三分之二可以通过对所有患病和小型新生儿实施现有的低成本循证干预措施来避免。将数据捕获与教育和临床决策支持相结合的开源数字质量改进工具（Neotree）是解决这一实施差距的有前途的解决方案。
■我们提供了在马拉维和津巴布韦的3家医院试点实施Neotree的成本分析结果。
■我们结合了基于活动的成本计算和支出方法，以估算马拉维一家医院的Neotree飞行员的开发和实施成本，Kamuzu中心医院（KCH），和津巴布韦的两家医院，SallyMugabe中心医院（SMCH）和Chinhoyi省立医院（CPH）。我们从提供商的角度估算了12个月内的成本。数据是通过支出报告收集的，每月员工使用时间调查，和项目人员面试。进行了敏感性和情景分析，以评估不确定性对结果的影响或按规模估计潜在成本。在KCH和未实施Neotree的可比医院进行了试点时间运动调查。
■在KCH试点实施Neotree的总成本，SMCH,CPH分别为37,748美元、52,331美元和41,764美元。每个入院儿童的平均每月费用分别为15美元、15美元和58美元。员工成本是主要的成本组成部分(平均占总成本的73%，从63%到79%)。敏感性分析的结果表明，入院人数的不确定性对所有医院的成本都有重大影响。在马拉维,用服务器替换每月的网络托管也对成本产生了重大影响。在常规(非研究)条件和规模下，估计总成本将大幅下降，高达76%,将每个入学儿童的费用降低到低至KCH的5美元，US$4inSMCH,和14美元的CPH。使用Neotree（n=250）接纳婴儿的中位时间为27（IQR20-40）分钟，而使用纸质系统（n=34）则为26（IQR21-30）分钟，新生儿出院的中位时间为9(IQR7-13)分钟(n=246)，而纸质系统为3(IQR2-4)分钟(n=50)。
■Neotree是一种时间和成本高效的工具，与低收入和中等收入国家有限的类似mHealth决策支持工具的结果具有可比性。Neotree的实施成本在不同的医院之间差异很大，主要是由于医院的规模。由于与卫生系统的整合以及人员和间接费用等成本项目的减少，由于规模经济，实施成本可以大大减少。需要更多的研究来评估大规模mHealth决策支持工具的影响和成本效益。
■我们提供了在马拉维和津巴布韦的3家医院试点实施Neotree的成本分析结果。
■我们结合了基于活动的成本计算和支出方法，以估算马拉维一家医院的Neotree飞行员的开发和实施成本，Kamuzu中心医院（KCH），和津巴布韦的两家医院，SallyMugabe中心医院（SMCH）和Chinhoyi省立医院（CPH）。我们从提供商的角度估算了12个月内的成本。数据是通过支出报告收集的，每月员工使用时间调查，和项目人员面试。进行了敏感性和情景分析，以评估不确定性对结果的影响或按规模估计潜在成本。在KCH和未实施Neotree的可比医院进行了试点时间运动调查。
■在KCH试点实施Neotree的总成本，SMCH,CPH分别为37,748美元、52,331美元和41,764美元。每个入院儿童的平均每月费用分别为15美元、15美元和58美元。员工成本是主要的成本组成部分(平均占总成本的73%，从63%到79%)。敏感性分析的结果表明，入院人数的不确定性对所有医院的成本都有重大影响。在马拉维,用服务器替换每月的网络托管也对成本产生了重大影响。在常规(非研究)条件和规模下，估计总成本将大幅下降，高达76%,将每个入学儿童的费用降低到低至KCH的5美元，US$4inSMCH,和14美元的CPH。使用Neotree（n=250）接纳婴儿的中位时间为27（IQR20-40）分钟，而使用纸质系统（n=34）则为26（IQR21-30）分钟，新生儿出院的中位时间为9(IQR7-13)分钟(n=246)，而纸质系统为3(IQR2-4)分钟(n=50)。
■Neotree是一种时间和成本高效的工具，与低收入和中等收入国家有限的类似mHealth决策支持工具的结果具有可比性。Neotree的实施成本在不同的医院之间差异很大，主要是由于医院的规模。由于与卫生系统的整合以及人员和间接费用等成本项目的减少，由于规模经济，实施成本可以大大减少。需要更多的研究来评估大规模mHealth决策支持工具的影响和成本效益。
