Lin, IL;
McCollum, ED;
Buckley, E;
Collins, JH;
Graham, MM;
Janoušková, E;
King, C;
... Colbourn, T; + view all
(2025)
The impact and cost-effectiveness of pulse oximetry and oxygen on acute lower respiratory infection outcomes in children in Malawi: a modelling study.
Lancet Global Health
, 13
(8)
e1466-e1475.
10.1016/S2214-109X(25)00202-5.
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Abstract
Background: acute lower respiratory infections (ALRIs) are the leading global cause of post-neonatal death in children younger than 5 years. The impact, cost, and cost-effectiveness of routine pulse oximetry and oxygen on ALRI outcomes at scale remain unquantified. Methods: We evaluate the impact and cost-effectiveness of scaling up pulse oximetry and oxygen on childhood ALRI outcomes in Malawi using a new and detailed individual-based model, together with a comprehensive costing assessment for 2024 that includes both capital and operational expenditures. We model 15 scenarios ranging from no pulse oximetry or oxygen (null scenario) to high coverage (90% pulse oximetry usage and 80% oxygen availability) across the health system. Cost-effectiveness results are presented in incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) using a Malawi-specific cost-effectiveness threshold of US$80 per disability-adjusted life-year (DALY) averted. Findings: The cost-effective strategy is the full scale-up of pulse oximetry to 90% usage rate and oxygen to 80% availability. This combination results in 72% (95% CI 72–72) of hypoxaemic ALRI cases accessing oxygen, averting 71 000 (68 100–74 000) DALYs per year of implementation and 28% (27–29) of potential ALRI deaths, at an ICER of US$35 (33–36) per DALY averted and $924 (887–963) per death averted. The INHB is 40 200 (37 300–43 100) net DALYs averted. Interpretation: Pulse oximetry and oxygen are complementary cost-effective interventions in Malawi, where health expenditure is low, and should be scaled up in parallel. Funding: UK Research and Innovation, Wellcome Trust, Department for International Development, EU, Clinton Health Access Initiative, and Unitaid.
| Type: | Article |
|---|---|
| Title: | The impact and cost-effectiveness of pulse oximetry and oxygen on acute lower respiratory infection outcomes in children in Malawi: a modelling study |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/S2214-109X(25)00202-5 |
| Publisher version: | https://doi.org/10.1016/s2214-109x(25)00202-5 |
| Language: | English |
| Additional information: | Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. |
| Keywords: | Humans, Malawi, Oximetry, Cost-Benefit Analysis, Respiratory Tract Infections, Infant, Child, Preschool, Acute Disease, Oxygen, Infant, Newborn, Female, Male, Oxygen Inhalation Therapy, Disability-Adjusted Life Years |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10211783 |
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