The impact and cost-effectiveness of pulse oximetry and oxygen on acute lower respiratory infection outcomes in children in Malawi: a modelling study
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2025-08-01
Date Acceptance
2025-07-01
Citation
The Lancet Global Health, 2025, 13 (8), pp.e1466-e1475
ISSN
2214-109X
Publisher
Elsevier BV
Start Page
e1466
End Page
e1475
Journal / Book Title
The Lancet Global Health
Volume
13
Issue
8
Copyright Statement
© 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
License URL
Subjects
Humans
Respiratory Tract Infections
Acute Disease
Oxygen
Oximetry
Oxygen Inhalation Therapy
Child, Preschool
Infant
Infant, Newborn
Cost-Benefit Analysis
Malawi
Female
Male
Disability-Adjusted Life Years
Publication Status
Published
Date Publish Online
2025-07-22