Evaluation économique des programmes de soins néonataux dans un essai contrôlé randomisé par grappes à Sylhet, Bangladesh

Translated title of the contribution: Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh

Amnesty E. Lefevre, Samuel D. Shillcut, Hugh R. Waters, Sabbir Haider, Shams El Arifeen, Ishtiaq Mannan, Habibur R. Seraji, Rasheduzzaman Shah, Gary L. Darmstadt, Steve N. Wall, Emma K. Williams, Robert E. Black, Mathuram Santosham, Abdullah H. Baqui

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh. Methods In a cluster-randomized controlled trial, two strategies for neonatal care - known as home care and community care - were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy - compared with that of the pre-existing levels of maternal and neonatal care - was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis. Findings The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$2971 (95% CI: 1844-7628) and US$104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective - with 95% certainty - if healthy life years were valued above US$214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective. Conclusion The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.

Translated title of the contributionEconomic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh
Original languageFrench
Pages (from-to)736-745
Number of pages10
JournalBulletin of the World Health Organization
Volume91
Issue number10
DOIs
StatePublished - Oct 2013

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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