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CRITICAL CARE: Scientists underline the basics

May 26, 2023
CRITICAL CARE: Scientists underline the basics
A snip from the PharmacoEconomics – Open journal with insets of Ifakara Health Institute scientists - Tim Baker and Karima Khalid who contributed to the study and publication. GRAPHIC | IFAKARA/KMC.

A team of scientists recommend the use of basic critical care approaches for critically ill patients. The care approaches must be “a highly cost-effective investment” and beneficial to a patient’s needs claimed the scientists.

The suggestion to use a basic critical care approach which is technically known as “Essential Emergency and Critical Care (EECC)” was given after the scientists investigated the cost-effectiveness of providing EECC - involving vital signs monitoring, oxygen therapy, and intravenous fluids and Advanced Critical Care (ACC) involving mechanical ventilators in intensive care units - in comparison with providing ‘no critical care’ or ‘district hospital-level critical care’ using COVID-19 as a tracer condition.

Contributing authors of the study were from UK, Sweden, Tanzania and Kenya. Among them from Ifakara Health Institute were Tim Baker, August Kuwawenaruwa, Khamis Awadh and Karima Khalid. 

Others were Lorna Guinness (lead author), Hiral Anil Shah and Peter Baker from the Center for Global Development, UK; Carl Otto Schell from Karolinska Institutet, Sweden; and Angela Kairu, Vincent Were and Edwine Barasa from KEMRI Wellcome Trust Research Programme, Kenya.

The EECC approach is a cost-effective investment
Results from the study were published in the PharmacoEconomics – Open journal on May 13, whereby the researchers confirmed the EECC approach as a highly cost-effective investment. 

“For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost-effectiveness falls within the range considered 'highly cost effective'.”

Based on the study results EECC was 94% cost-effective 99% of the time when compared to ACC which was 27% cost-effective 40% of the time. Both approaches were also compared with the no critical care or district hospital-level critical care scenarios simultaneously.

Policymakers should scale up the EECC approach
Despite the effectiveness of the EECC approach, its coverage especially in low-resource settings was found to be notably low by the researchers who urged policymakers to find better ways to scale up the approach in situations other than when involving COVID-19 patients.

“The findings indicate that EECC is more cost-effective than ACC. While investing in EECC will benefit all critically ill patients, further data are required to provide more robust findings, and further development of the model will be required to explore this beyond the treatment of COVID-19 patients.”

Currently, EECC is distinguished by three principles. They include first, giving priority to those with the most urgent clinical need, including both early identification and timely care; second, providing life-saving treatments that support failing vital organ functions; and third, focusing on effective care of low cost and low complexity. 

Exploring the potential of EECC in COVID-19 patients
In the study, the researchers developed a Markov model for a hypothetical cohort of 10,000 hospitalized critically ill adult patients with COVID-19 in Tanzania. 

The model was used to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, with patients evaluated over a time period of 28 days to capture an inpatient episode, over a 24-hour period. Patient outcomes were obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. 

“Our results can contribute towards evidence-informed policy-making and policy planning of critical care services not only during the COVID-19 pandemic but also in providing critical illness care across all conditions.”

In this particular study, EECC was a highly cost-effective (94%) investment more than ACC (24%) for providing care to critically ill patients with COVID-19 in settings where little or no critical care was available.

However, the researchers were keen to point out the need for further research to explore the potential of EECC to produce even greater benefits and value for money for all critically ill patients other than those with COVID-19. 

Read the full publication: https://pubmed.ncbi.nlm.nih.gov/37178434/