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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.
SUBMITTER: LeFevre AE
PROVIDER: S-EPMC3791651 | biostudies-literature | 2013 Oct
REPOSITORIES: biostudies-literature
LeFevre Amnesty E AE Shillcutt Samuel D SD Waters Hugh R HR Haider Sabbir S El Arifeen Shams S Mannan Ishtiaq I Seraji Habibur R HR Shah Rasheduzzaman R Darmstadt Gary L GL Wall Steve N SN Williams Emma K EK Black Robert E RE Santosham Mathuram M Baqui Abdullah H AH
Bulletin of the World Health Organization 20130712 10
<h4>Objective</h4>To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh.<h4>Methods</h4>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 ...[more]