Background: The existing WHO integrated management of common childhood illness (IMCI) guideline is not specific enough to detect signs of severe pneumonia. Providing pulse oximetry at health centres improves the diagnosis of severe pneumonia. However, no studies estimated the cost-effectiveness of combined use of pulse oximeter with IMCI to diagnosing severe childhood pneumonia as compared to IMCI strategy alone. Such evidence is needed in health care priority setting and is important for decision support for policy makers.

Methods: This cost-effectiveness study was carried out a long side a parallel cluster randomized controlled trial at health centres in Southern Ethiopia from September 2018 to April 2019. Costs were analysed from societal perspective in 2019 US$. Options of diagnosing severe childhood pneumonia using both IMCI and pulse oximeter and IMCI only were compared in twenty four health centres. The measure of effectiveness was to diagnose severe pneumonia. Tree Age Pro Suit (Tree Age software) was used for building a decision tree model and data analysis. Incremental cost-effectiveness ratio (ICER) was used to summarize and present the cost-effectiveness result.

Result: The proportion of children diagnosed as severe pneumonia in the intervention arm was 15.9% (148 of 928 children), while in the control arm the proportion was 3.9% (34 of 876 children). The total cost for each diagnosed severe pneumonia was higher in intervention arm (US$ 1.85) compared with control arm (US$ 0.69). Supplementing WHO IMCI strategy with pulse oximeter added a total cost of US$ 1.14 per diagnosed severe pneumonia cases. The intervention arm has an incremental cost effectiveness ratio of US$ 9.61 per diagnosed severe childhood pneumonia.

Conclusion: Supplementing the WHO IMCI strategy with pulse oximeter is cost-effective, and pulse oximeters should be considered used at health centres in Ethiopia.

Trial registration: PACTR201807164196402 (registered 14/06/2018). URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3466