Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis

Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries.

Over five years, the expected gap in emergency caesarean deliveries was 157 000. The US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case, and US$251 in the most pessimistic scenario— considered to be a very good value for Kenya at less than 20% of per capita GDP per life-year gained.