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    • aa-dutp Our assumptions are all conservative and our results

    2018-11-09

    Our assumptions are all conservative and our results are robust to variance on the dimensions of uncertainty as demonstrated in Table 4. Our estimates understate the DALYs gained from each device in that they don’t include the health benefits to the unborn child from improved diagnosis of pre-eclampsia, which are likely quite substantial. These results do not provide accurate absolute cost effectiveness of testing in scenarios where diagnostic equipment are not already accessible and must be purchased; however, the analysis does provide informative data on the relative cost effectiveness of testing women for preeclampsia using these common technologies. Cost-effectiveness analysis considers every stage of implementation in the local environment from when the patient presents at a health facility through diagnosis, treatment and patient outcome. By taking into account the big picture, it aa-dutp makes implicit tradeoffs explicit such as diagnosis versus treatment or cost versus effectiveness. In settings where treatment is rationed or unavailable, the most effective diagnostic device is not necessarily the most desirable, but rather the one that achieves a certain threshold of effectiveness at the lowest cost. Our results provide additional evidence that \"hand me down\" technology from high-income countries is unlikely to be appropriate in LMICs because developed countries have focused on the most effective solution, regardless of cost (Howitt et al., 2012; Malkin, 2007; Free, 2004). Our results have important implications for routine healthcare provision in both clinical and policy contexts. While other studies have evaluated the cost effectiveness of screening and treatment strategies in high income countries, to our knowledge no other study has evaluated the cost effectiveness of medical screening technologies designed for use in LMIC. Cost-effectiveness analysis is an important tool that incorporates information about the local environment to produce tailored policies, devices, and procedures. These are the type of results needed to inform evidence-based medicine, which allows policy-makers to standardize procedures in LMICs and thereby reduce maternal mortality. This study was designed to help translate scientific advances into policy and practice in LMICs. We provide a clear framework for decision-making and assess the areas that are most sensitive to uncertainty. In the era of implementation science and implementation engineering, cost-effectiveness should guide not only the development of new devices and procedures but also the implementation and evaluation (Johnson, 2013).
    Authors\' contributions
    Funding University of Michigan Center for Global Health Jr. Faculty Engagement Award (Sienko); University of Michigan Institute for Research on Women and Gender\'s Faculty Seed Grant (McLaren); Fogarty International Center at the National Institutes of Health, Grant Number 1R24TW008814-01: Ghana-Michigan Postdoctoral And Research Training NetwoRk (PARTNER) Program (Sienko, Akazili); National Science Foundation Graduate Research Fellowship (Sabet Sarvestani); University of Michigan Third Century Initiative.
    Conflicts of interest
    Role of the funding source
    Ethical approval
    Acknowledgements
    Introduction Televisions (TVs) are among the most commonly used household appliances. Estimates indicate that more than 80% of the world\'s 1.9 billion households owned TVs in 2014 (Digital TV Research, 2014). Although TV penetration in developed economies is already saturated, TV ownership in developing countries is still low, e.g., estimated at less than 40% in sub-Saharan Africa (Digital TV Research, 2014); as a result, demand for TVs is high in these countries, including in off-grid regions where an estimated 1.2 billion people worldwide lack access to electricity and in unreliable-grid regions where an additional 1 billion people reside (Global LEAP, 2016a; International Energy Agency (IEA), 2015). A recent market survey of anticipated off-grid consumer demand found that TVs were in the top three household end uses (along with light emitting diode [LED] lamps and mobile phone chargers) (Global LEAP, 2015a). Another recent analysis estimated that the number of off- and unreliable-grid households for TVs in Asia and Africa would grow from about 50 million in 2015 to about 200 million by 2020 as the distribution of energy systems increases (Global LEAP, 2016a).