Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability. Issue 10 (21st October 2020)

• Record Type: Journal Article
• Authors: Pulkki-Brännström, Anni-Maria; Haghparast-Bidgoli, Hassan; Batura, Neha; Colbourn, Tim; Azad, Kishwar; Banda, Florida; Banda, Lumbani; Borghi, Josephine; Fottrell, Edward; Kim, Sungwook; Makwenda, Charles; Ojha, Amit Kumar; Prost, Audrey; Rosato, Mikey; Shaha, Sanjit Kumer; Sinha, Rajesh; Costello, Anthony; Skordis, Jolene
• Is Part Of: Health policy and planning. Volume 35:Issue 10(2020)
• Page Start: 1280
• Page End: 1289
• Publication Date: 2020-10-21
• Subjects: Costs -- cost-effectiveness analysis -- randomized controlled trial -- maternal and child health -- community mobilization; Medical policy -- Developing countries -- Periodicals; Public health -- Developing countries -- Periodicals; Health planning -- Developing countries -- Periodicals; 362.1091724
• DOI: 10.1093/heapol/czaa081
• Languages: English
• ISSNs: 0268-1080

Abstract

Abstract: WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61–$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.