A Nighttime Telemedicine and Medication Delivery Service to Avert Pediatric Emergencies in Haiti: An Exploratory Cost-Effectiveness Analysis

Abstract

We sought to compare the costs of a nighttime pediatric telemedicine and medication delivery service per disability-adjusted life year (DALY) averted to the costs of current hospital emergency care per DALY averted from a societal perspective. We studied a nighttime pediatric telemedicine and medication delivery service and hospital emergency care in a semi-urban and rural region of Haiti. Costs of the two services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the "years lives lost" and "years lost to disability" from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from 0 to 9 years old. The incremental cost-effectiveness ratio was estimated and compared with the per capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an incremental cost-effectiveness ratio less than three times the per capita GDP of Haiti ($3,531). The total costs of the nighttime telemedicine and medication delivery service and hospital emergency care to society were $317,898 per year and $89,392 per year, respectively. The DALYs averted by the service and hospital emergency care were 199.76 and 22.37, respectively. Correspondingly, the incremental cost-effectiveness ratio is estimated at $1,288 signifying that the service costs an additional $1,288 to avert one additional DALY. A scaled nighttime pediatric telemedicine and medication delivery service is likely a cost-effective alternative to hospital emergency care for pre-emergency pediatric conditions in Haiti, and possibly in similar lower-middle-income countries.

Figure 1.

Scaled MotoMeds workflow. This figure appears in color at www.ajtmh.org.

Figure 2.

Costs and effects of MotoMeds telemedicine and medication delivery service. This figure appears in color at www.ajtmh.org.

Figure 3.

Costs and effects of hospital emergency care. This figure appears in color at www.ajtmh.org.

Figure 4.

Sensitivity analysis. Univariate sensitivity analysis was performed to evaluate how uncertainty of individual parameter estimates affected the Incremental Cost Effectiveness Ratio in relation to the per capita GDP in Haiti. The vertical orange line designates the per capita GDP of Haiti ($1,177). Two times the per capita GDP is $2,354. Three times the per capita GDP is $3,531 (the cost-effectiveness threshold). This figure appears in color at www.ajtmh.org.