Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji

• Published in: BMC health services research Vol. 21; no. 1; pp. 1 - 636
• Main Authors: McAllister, Susan, Thorn, Louise, Boladuadua, Sainimere, Gil, Mireia, Audas, Rick, Edmonds, Tim, Rafai, Eric, Hill, Philip C, Howie, Stephen R. C
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 02.07.2021; BioMed Central; BMC
• Subjects: Analysis; Capital costs; Capital expenditures; Cost; Cost analysis; Cost control; Cost estimates; Discount rates; Economic aspects; Equipment and supplies; Fiji; Health facilities; Health services; Hospitals; Hospitals, Public; Management; Medical care, Cost of; Net present value; Operating costs; Oxygen concentrators; Oxygen equipment (Medical care); Pneumonia; Success factors; Fiji; New Zealand; United States > US
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-06687-8

Abstract Background Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide. Methods Data sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars. Results Critical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost. Conclusion Introducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.