Forecasting burden of long-term disability from neonatal conditions: Results from the Projahnmo i trial, Sylhet, Bangladesh

Samuel D. Shillcutt, Amnesty E. Lefevre, Anne C.C. Lee, Abdullah H. Baqui, Robert E. Black, Gary L. Darmstadt

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction The burden of disease resulting from neonatal conditions is substantial in developing countries. From 2003 to 2005, the Projahnmo I programme delivered community-based interventions for maternal and newborn health in Sylhet, Bangladesh. This analysis quantifies burden of disability and incorporates non-fatal outcomes into cost-effectiveness analysis of interventions delivered in the Projahnmo I programme.Methods A decision tree model was created to predict disability resulting from preterm birth, neonatal meningitis and intrapartum-related hypoxia ('birth asphyxia'). Outcomes were defined as the years lost to disability (YLD) component of disability-adjusted life years (DALYs). Calculations were based on data from the Projahnmo I trial, supplemented with values from published literature and expert opinion where data were absent.Results 195 YLD per 1000 neonates [95% confidence interval (CI): 157-241] were predicted in the main calculation, sensitive to different DALY assumptions, disability weights and alternative model structures. The Projahnmo I home care intervention may have averted 2.0 (1.3-2.8) YLD per 1000 neonates. Compared with calculations based on reductions in mortality alone, the cost-effectiveness ratio decreased by only 0.6% from $105.23 to $104.62 ($65.15-$266.60) when YLD were included, with 0.6% more DALYs averted [total 338/1000 (95% CI: 131-542)].Discussion A significant burden of disability results from neonatal conditions in Sylhet, Bangladesh. Adding YLD has very little impact on recommendations based on cost-effectiveness, even at the margin of programme adoption. This model provides guidance for collecting data on disabilities in new settings.

Original languageEnglish (US)
Pages (from-to)435-452
Number of pages18
JournalHealth policy and planning
Volume28
Issue number4
DOIs
StatePublished - Jul 2013

Keywords

  • Summary measures
  • burden of illness
  • cost-effectiveness
  • neonatal health
  • outcomes research
  • years lost to disability

ASJC Scopus subject areas

  • Health Policy

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