PT - JOURNAL ARTICLE AU - Hamish R Graham AU - Ayobami A Bakare AU - Adejumoke Idowu Ayede AU - Joseph Eleyinmi AU - Oyaniyi Olatunde AU - Oluwabunmi R Bakare AU - Blessing Edunwale AU - Eleanor F G Neal AU - Shamim Qazi AU - Barbara McPake AU - David Peel AU - Amy Z Gray AU - Trevor Duke AU - Adegoke G Falade TI - Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria AID - 10.1136/bmjgh-2022-009278 DP - 2022 Aug 01 TA - BMJ Global Health PG - e009278 VI - 7 IP - 8 4099 - http://gh.bmj.com/content/7/8/e009278.short 4100 - http://gh.bmj.com/content/7/8/e009278.full SO - BMJ Global Health2022 Aug 01; 7 AB - Introduction Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme.Methods Prospective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January–March 2021), summary admission data (January 2018–December 2020), programme cost data. Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support. Primary outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO2 <90%) children who received oxygen. Comparison across three time periods: preintervention (2014–2015), intervention (2016–2017) and follow-up (2018–2020) using mixed-effects logistic regression. Calculated cost-effectiveness of the intervention on child pneumonia mortality using programme costs, recorded deaths and estimated counterfactual deaths using effectiveness estimates from our effectiveness study. Reported cost-effectiveness over the original 2-year intervention period (2016–2017) and extrapolated over 5 years (2016–2020).Results Pulse oximetry coverage for neonates and children remained high during follow-up (83% and 81%) compared with full oxygen system period (94% and 92%) and preintervention (3.9% and 2.9%). Oxygen coverage for hypoxaemic neonates/children was similarly high (94%/88%) compared with full oxygen system period (90%/82%). Functional oxygen sources were present in 11/12 (92%) paediatric areas and all (8/8) neonatal areas; three-quarters (15/20) of wards had a functional oximeter. Of 32 concentrators deployed, 23/32 (72%) passed technical testing and usage was high (median 10 797 hours). Estimated 5-year cost-effectiveness US$86 per patient treated, $2694–4382 per life saved and $82–125 per disability-adjusted life year-averted. We identified practical issues for hospitals and Ministries of Health wishing to adapt and scale up pulse oximetry and oxygen.Conclusion Hospital-level improvements to oxygen and pulse oximetry systems in Nigerian hospitals have been sustained over the medium-term and are a highly cost-effective child pneumonia intervention.Data are available upon reasonable request. Anonymised clinical data are available on reasonable request to the corresponding author. All other data are fully available in the manuscript and supplemental material.