Desmond Chris, Bland Ruth M, Boyce Gerard, Coovadia Hoosen M, Coutsoudis Anna, Rollins Nigel, Newell Marie-Louise
Human Sciences Research Council, Durban, South Africa.
PLoS One. 2008 Jun 18;3(6):e2454. doi: 10.1371/journal.pone.0002454.
Exclusive breastfeeding (EBF) for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requires effective personnel and management to ensure quality counselling and support for women. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal.
The costing of the intervention as implemented was calculated, in addition to the modelling of the costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol), simplified version (half the number of visits compared to the full intervention; more clinic compared to home visits) and basic version (one third the number of visits compared to the full intervention; all clinic and no home visits). Implementation of the full scenario costs R95 million ($14 million) per annum; the simplified version R47 million ($7 million) and the basic version R4 million ($2 million). Although the cost of the basic scenario is less than one tenth of the cost of the simplified scenario, modelled effectiveness of the full and simplified versions suggest they would be 10 times more effective compared to the basic intervention. A further analysis modelled the costs per increased month of EBF due to each intervention: R337 ($48), R206 ($29), and R616 ($88) for the full, simplified and basic scenarios respectively. In addition to the average cost effectiveness the incremental cost effectiveness ratios associated with moving from the less effective scenarios to the more effective scenarios were calculated and reported: Nothing-Basic R616 ($88), Basic-Simplified R162 ($23) and Simplified-Full R879 ($126).
The simplified scenario, with a combination of clinic and home visits, is the most efficient in terms of cost per increased month of EBF and has the lowest incremental cost effectiveness ratio.
六个月纯母乳喂养是全球儿童健康的支柱，也是对不适合采用替代喂养的感染艾滋病毒母亲的首选喂养方式。在社区层面推广纯母乳喂养需要有效的人员配备和管理，以确保为妇女提供高质量的咨询和支持。我们对南非艾滋病毒高流行地区一项成功的促进纯母乳喂养干预措施进行了成本核算和成本效益分析，并探讨了在夸祖鲁 - 纳塔尔省扩大规模的影响。
除了计算所实施干预措施的成本外，还对在三种不同情况下在省级层面开展该干预措施的成本和结果进行了建模：全面干预（按方案执行）、简化版（与全面干预相比访视次数减半；门诊访视多于家访）和基础版（与全面干预相比访视次数减少三分之二；全部为门诊访视且无家访）。全面方案实施每年成本为9500万兰特（1400万美元）；简化版为4700万兰特（700万美元），基础版为400万兰特（200万美元）。尽管基础方案的成本不到简化方案成本的十分之一，但全面版和简化版的模拟效果表明，它们的效果比基础干预措施高10倍。进一步分析对每种干预措施导致的纯母乳喂养增加月份的成本进行了建模：全面、简化和基础方案分别为337兰特（48美元）、206兰特（29美元）和616兰特（88美元）。除了平均成本效益外，还计算并报告了从不太有效的方案转向更有效方案的增量成本效益比：基础版 - 无干预为616兰特（88美元），基础版 - 简化版为162兰特（23美元），简化版 - 全面版为879兰特（126美元）。
结合门诊访视和家访的简化方案，在每增加一个月纯母乳喂养的成本方面最为高效，且增量成本效益比最低。
