Decision analysis of novel point-of-care diagnostics for Pediatric Pneumonia : implementation in Developing countries with tiered healthcare systems

Abstract

Pediatric Pneumonia (PNA) is the single leading cause of death in children under five, accounting for 19% of all childhood deaths worldwide. Due to severe resource constraints on healthcare, the global burden of the disease in children is disproportionately shared by developing countries. In particular, India, having the highest incidence rate of PNA, accounts for more than 30% of the world's neonatal deaths from pneumonia every year. The three-tier referral systems, shared by many other developing countries, has introduced inefficiencies into delivering appropriate healthcare to patients in need. Point-of-care (POC) diagnostics is a type of tool used to assist physicians to make clinical decisions. Its key advantage include the quick turnaround of results, low cost and high diagnostic power could potentially improve India's pressing situation due to pneumonia. Since the disease progresses quickly in infants and babies and transportation of patients within the healthcare system is time consuming, POC diagnostic is crucial in lowering both the mortality of children with pneumonia and the cost of treating PNA. To this effect, we investigate the potential impact of POC diagnostics when implemented in a three-tier referral system. Using India as a case country, I construct a decision tree model that evaluates cost, mortality, and the combined cost-effectiveness in Tree-Age software as a framework which evaluates five implementation strategies of a POC diagnostic for PNA within the Indian public healthcare system. The strategies reflect various prescription decisions and referral patterns in current medical practice in India. I concluded that (1) the diagnostic will result in both higher cost and mortality in areas where the practice is to provide all patients antibiotics and thus not recommended, (2) the diagnostic is very likely to achieve lower cost and mortality when patients do not always receive antibiotics and sometimes are given only symptom-relieving drugs and thus recommended, (3) the diagnostic has great potential in generating savings by limiting patients from being transported to urban hospitals, (4) when dual diagnostic is employed combining POC diagnostics and X-ray, confirming positive cases from the diagnostic by X-ray results in lower cost and confirming negative cases results in lower mortality and (5) the diagnostic can save resources and benefit health outcomes and should be implemented in places where X-ray is not available.