Palmer, Tom;
Chimhuya, Simbarashe;
Khan, Nushrat;
Cortina-Borja, Mario;
Wilson, Emma;
Hull-Bailey, Tim;
Gannon, Hannah;
... Heys, Michelle; + view all
(2026)
Impact and cost-effectiveness of Neotree, a digital data capture and decision support tool designed to improve neonatal survival in Zimbabwe: an interrupted time series analysis and economic evaluation.
BMJ Global Health
, 11
(1)
, Article e016828. 10.1136/bmjgh-2024-016828.
Preview |
Text
Palmer_e016828.full.pdf Download (1MB) | Preview |
Abstract
Introduction: Many neonatal deaths are avoidable using existing low-cost evidence-based interventions. This study evaluated the effectiveness and cost-effectiveness of Neotree, a digital quality improvement tool combining data capture with education and clinical decision support, implemented in a Zimbabwean hospital. // Methods: Neotree was implemented in Chinhoyi Provincial Hospital (CPH) in December 2020. Using data collected for all neonates admitted to CPH from March 2020 to October 2023, a single group interrupted time series analysis was conducted to estimate the impact of Neotree implementation. Subgroup analyses explored the impact in low birth weight (1.5–2.5 kg) neonates, a key group targeted by the intervention. Activity-based costing and expenditure approaches estimated costs of developing and implementing Neotree in CPH from a provider perspective. Both total within-study costs and total costs at scale were estimated and used to derive cost per life saved, cost per life year saved and cost per healthy life year (HLY) gained. // Results: Analysis suggests reduced overall mortality in the post-implementation period, though this difference was not statistically significant (RR: 0.877, 95% CI 0.541 to 1.423, p=0.596). This was primarily driven by reduced mortality among the low birth weight subgroup (RR: 0.356, 95% CI 0.127 to 1.002, p=0.051). Cost-effectiveness analysis based on an assumed mortality impact in this subgroup suggests a within-study cost of around $28.44 per HLY gained, reducing to $6.35 per HLY gained at scale, substantially below the range of potential cost-effectiveness thresholds considered for Zimbabwe (US $17– US $855). // Conclusion: Neotree is a potentially low-cost and highly cost-effective digital quality improvement tool to improve newborn care, morbidity and survival, while also providing quality data. This study contributes to limited economic evidence of mHealth tools in low-income and middle-income settings.
Archive Staff Only
 |
View Item |
