{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T01:14:50Z","timestamp":1772846090160,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010554","name":"Clinical and Translational Science Institute, University of Pittsburgh","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010554","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pneumonia is the leading cause of death globally in children aged 0\u20135 years. Early access to pulse\u2010oximetry and supplemental oxygen in low\u2010resource, pre\u2010hospital settings may result in improved pediatric pneumonia outcomes. However, few data exist regarding their application in such settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed an exploratory cost\u2010effectiveness analysis using a decision analytic model to examine use of pulse\u2010oximetry and supplemental oxygen in pre\u2010hospital environments of Malawi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our model yielded an Incremental Cost\u2010Effectiveness Ratio (ICER) for pre\u2010hospital pulse\u2010oximetry use of $35 (USD) per disability\u2010adjusted life\u2010year (DALY) averted compared to no pulse\u2010oximetry use. One\u2010way sensitivity analysis showed highest sensitivity to the parameter of downstream hospitalization cost. Given that inpatient management is the standard of care for hypoxemic pneumonia, when only pre\u2010hospital costs were considered the result was an ICER of $9.9\/DALY averted. Both values were considered cost\u2010effective according to a conservative willingness\u2010to\u2010pay (WTP) threshold set for 1x the average GDP per capita in Malawi ($588, 2018). When oxygen was analyzed in combination with pulse\u2010oximetry, we found a baseline WTP threshold for pre\u2010hospital oxygen of $71 per patient. For every 1% reduction in total pediatric pneumonia mortality consequent to pre\u2010hospital oxygen use, we determined the recommended WTP allowance for oxygen would increase by approximately $4.53.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We conclude that pulse\u2010oximetry is likely cost\u2010effective in low\u2010resource, pre\u2010hospital environments. We acknowledge the need for further research on the effectiveness of pre\u2010hospital oxygen in reducing pediatric pneumonia mortality and suggest ranges of cost and efficacy for which oxygen is likely to be found cost\u2010effective in tandem with pulse\u2010oximetry.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71095","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T02:20:16Z","timestamp":1746498016000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre\u2010Hospital Pulse\u2010Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost\u2010Effectiveness Analysis"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2528-6378","authenticated-orcid":false,"given":"James B.","family":"Newton","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of North Carolina Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4122-0937","authenticated-orcid":false,"given":"Michael T.","family":"Hawkes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Katenga\u2010Kaunda","sequence":"additional","affiliation":[{"name":"Salima District Hospital, Salima District Council Salima Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8088-566X","authenticated-orcid":false,"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"},{"name":"School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.10.009"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31593-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61901-1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007468"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.0228"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.048512"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.16.173401"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0136166"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00737-0"},{"key":"e_1_2_9_11_1","unstructured":"Unicef \u201cCountry profiles Malawi \u201d [Online] accessed February 6 2025 https:\/\/data.unicef.org\/country\/mwi\/."},{"key":"e_1_2_9_12_1","unstructured":"World Bank Group \u201cData Rural population (% of Total Population) \u201d [Online] accessed February 6 2025 https:\/\/data.worldbank.org\/indicator\/SP.RUR.TOTL.ZS?locations=MW."},{"key":"e_1_2_9_13_1","unstructured":"World Bank Group \u201cHuman Capital Data Portal Economies \u201d [Online] accessed February 6 2025 https:\/\/humancapital.worldbank.org\/en\/economy\/MWI."},{"key":"e_1_2_9_14_1","unstructured":"United Nations Development Programme \u201cHuman Development Insights \u201d [Online] accessed February 6 2025 https:\/\/hdr.undp.org\/data-center\/country-insights#\/ranks."},{"key":"e_1_2_9_15_1","unstructured":"UN Inter\u2010agency Group for Child Mortality Estimation. \u201cCauses of Death Malawi \u201d [Online] accessed February 6 2025 https:\/\/childmortality.org\/causes-of-death\/data?refArea=MWI&d_refArea=&type=FRACTION."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242440"},{"key":"e_1_2_9_17_1","unstructured":"US Bureau of Labor Statistics \u201cConsumer Price Index \u201d [Online] http:\/\/www.bls.gov\/cpi\/#data."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0031239"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.15172\/pneu.2015.6\/621"},{"key":"e_1_2_9_20_1","volume-title":"Revised WHO Classification and Treatment of Childhood Pneumonia at Health Facilities; 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