Harnessing technology to create a sustainable and affordable intensive care unit model in lower-income countries

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Glowing monitors in intensive care department. Nigth shift at icu, patient in critical state
Innovative technologies can help address gaps in ICU care in developing countries. Copyright: Kiryl Lis/Shutterstock

Critical care consumes a substantial proportion of a country’s health care expenditure. This was especially true during the COVID-19 pandemic and increasingly true as populations age and struggle with chronic conditions.

Current literature reports average costs of intensive care unit (ICU) care are between approximately $2,200 and $6,000 per day (adjusted to 2023 prices).  The delivery of critical care is less expensive in low- and middle-income countries (LMICs), largely due to much lower labor costs, but LMICs face other challenges in ICU care.

Limited ICU capacity

As we have seen from COVID-19, ICU capacity, including beds, equipment, and staff, can be limited to non-existent in lower income countries. As of 2020, there were between 0.1 and 2.5 ICU beds per 100,000 people in lower income countries, compared to 5.3 to 13.1 in high income countries. Most ICUs in such countries are also located in large referral hospitals in major cities, making it difficult for people in rural areas to access care.

In addition to the high costs incurred in ICUs, critical care costs are often not fully covered by health insurance systems and patients generally pay out-of-pocket for the visits in lower income countries, which usually leaves the most vulnerable at risk.

Innovative technologies can help address these gaps in ICU care in developing countries. Here are five solutions that are expanding capacity and improving the quality of care during inpatient hospital stays in LMICs at lower costs.

  1. Monitoring systems using artificial intelligence

A recent study shows sensing technology and artificial intelligence for autonomous and granular monitoring of critically ill patients and their environment in ICUs can be built with an estimated cost of < $300 per ICU room, a relatively low cost compared to daily ICU costs of thousands of dollars per patient. During COVID-19, monitoring interfaces that feed data into AI systems have been used to guide treatment decisions and diagnostics monitor critically ill patients. In high-income settings, AI and machine learning algorithms have been used to analyse ICU patients’ vital signs by administering repetitive patient assessments in real-time, learn from them, and help doctors make timely decisions.

  1. Low-cost wearable devices

Low-cost wearable devices provide attentive and continuous vital sign monitoring for critically ill patients at a significantly lower-cost. Conventionally, without these technologies, this is achieved using sophisticated continuous monitoring systems facilitated by high nurse-to-patient ratios, whichlow-resource settings find difficult to achieve due to lack of staff. Low-cost wearable devices show significant cost-savings and improved health outcomes. A recent study showed that these sensors resulted in, for example, a reduction in bedsores from spending a long time in a hospital bed compared to standard care. It also saved $6,621 per patient over a one-year period.

  1. Point-of-care diagnostics and imaging devices

Other low-cost innovative technologies used in ICUs, such as point-of-care (POC) diagnostic and imaging devices (hand-held ultrasounds) to reduce cost have been developed and used across many settings especially during the height of COVID-19 due to the risk of infection transmission. POC diagnostic techniques—which are usually performed near or at the site of patient care—are critical in timely monitoring and assessment of critically ill patients that could lead to an immediate modification of the ongoing therapy, outcome improvement and reduction of morbidity and mortality.  

  1. Tele-ICU

Tele-ICU has been expanding to address the increasing costs and demand for intensive care services and the shortage of ICU specialists. Tele-ICU is a technology-based model designed to deliver effective critical care in the ICU to provide diagnosis and treatment of the most critical hospital patients by a remote intensivist using technology such as videoconferencing. Tele-ICU is associated with substantial improvements in mortality, reduced hospital and ICU length of stay, and decreased health care costs; however, results show variation due to high installation costs and reluctance to accept tele-ICU from certain health care staff. However, telemedicine use substantially increased during the pandemic, even in low-income countries, which could be leveraged to adopt the tele-ICU model. Consequently, in low-resource settings, where shortages of health care professionals and ICU beds are prevalent, tele-ICU could be an alternate model to reduce long-term costs and improve access to health care services and health outcomes.

  1. Evidence-based guidelines and policies

Developing evidence-based clinical guidelines for innovative ICU models is essential to its successful implementation and sustainability of the operations. These guidelines should be simple and require inexpensive tools and equipment that can be quickly translated into action in low-income settings. It should include the resources required to provide it, the availability of trained providers and infrastructure available. The Asia Pacific Association of Critical Care Medicine has developed a set of evidence-based ICU admission guidelines for the region, including guidelines for innovative ICU models. In addition, the Vietnam Association of Critical Care Medicine is working to raise awareness of innovative ICU care through public education campaigns. Structured guidelines and protocols that are locally appropriate and based upon global best practices are essential to its success. A continuing focus on policy guidance and research will be key to advancing this agenda and improving outcomes of the most critically ill patients.

More evidence and implementation trials are needed

A World Bank project in eastern Colombia implemented tele-ICU for low-and middle-income patients in 22 hospitals as part of the Fundación Cardiovascular, the largest private sector health care network in the country. This service has reduced infant mortality in hospitals by over 70% and generated estimated cost savings of $10.5 million over the past two years. In addition,  a program implemented during COVID-19 in Brazil  offered specialized treatment to inaccessible and economically deprived  regions of the country.

Although more evidence around low-cost ICU innovations is needed, potential for new technology to transform health care in low-resource settings is substantial. There is a need for further evidence and implementation trials around low-cost ICU options to assess the actual effectiveness and feasibility, stronger collaboration with end-user communities to better understand the contextual need, and greater investment in affordable innovative technologies for improved care and cost savings.

 

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Authors

Christophe Lemiere

Program Leader for Human Development for Vietnam

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