improving the quality of care of sick children in district hospitals in kenya: a cost-effectiveness...
DESCRIPTION
The InterventionTRANSCRIPT
Improving the Quality of Care of Sick Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis
Barasa W. E, Ayieko P, Cleary S, English M
Background
• Under 5 mortality continues to be a challenge globally
• In Kenya the under 5 mortality rate needs to reduce by 50% to meet the MDG 4 target
• The district hospital is an important avenue for delivering cost-effective child health interventions
• The quality of care in these hospitals has however been found to be poor in Kenya
• A multifaceted intervention to improve inpatient care in these hospital was tested and found to be effective.
• We present here a cost effectiveness analysis of the intervention
The Intervention
Objectives and Methods
Objectives
• To determine the total economic
costs of delivering ETAT+
• To assess the cost effectiveness
of the intervention
• To model the costs of scale up of
ETAT+ to a national level
Methods• A cost-effectiveness analysis
(CEA) alongside a cRCT
• Provider perspective
• Horizon – 18 months (Sep 2006 – Apr 2008)
• One way sensitivity analysis conducted on development & hotel costs, effectiveness and salaries
MethodsSample sizes• Process of care: 1158 & 1157 at
18 months in intervention and control hospitals respectively
• Resource use: 6199 & 5115 in
intervention and control hospitals
respectively
Measuring costs•An ingredients approach•Costs of developing, implementing and treatment where evaluated
Measuring effectiveness•Quality of care measured using process of care that span assessment, diagnosis and treatment
Assessing Costs-Effectiveness• Intervention study not designed
to measure mortality as a primary outcome
• The ICER was defined as the incremental cost per % improvement in QoC
• We also assessed likely cost per DALY averted estimates assuming plausible relative reductions in baseline inpatient mortality rate (7%) of between 1% and 10%
• This corresponds to absolute reductions in mortality of between 0.07% and 0.7%
Results: Intervention Costs Summary
Results: Incremental Cost-Effectiveness Ratio
•The additional cost per 1 percentage improvement in quality of care (ICER) was US$ 0.78 per child admission
Results: Estimated Costs of Scale-up
•Total costs of scale-up are US$ 3,633,123.45
Results: “What-If” Analysis
ICERs of other Key Child health Interventions
Discussions: Should ETAT+ be scaled up?
• There is therefore a strong case to scale up ETAT+
amongst other MNCH interventions