Titre : | Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh (2013) |
Auteurs : | Amnesty-E LEFEVRE ; Samuel-D SHILLCUTT ; Projahnmo Study Group (Bangladesh) ; Hugh-R WATERS ; Department of International Health, Suite E-8139 (Baltimore MD, Etats-Unis) ; Child Health Unit, International Centre for Diarrhoeal Disease Research (Dhaka, Bangladesh) ; 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 |
Type de document : | Article |
Dans : | Bulletin of the world health organization (vol. 91, n° 10, Octobre 2013) |
Pagination : | 736-745 |
Langues: | Anglais |
Mots-clés : | Economie santé ; Nouveau né ; Soins ; Essai thérapeutique ; Randomisation ; Médecine tropicale ; OMS ; Homme ; Asie |
Résumé : | [BDSP. Notice produite par INIST-CNRS qR0xmok7. Diffusion soumise à autorisation]. 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. |
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077074 | - | Périodique | Rennes | Magasin | Empruntable Disponible |
077075 | - | Périodique | Rennes | Magasin | Empruntable Disponible |