Sinha Rajesh Kumar, Haghparast-Bidgoli Hassan, Tripathy Prasanta Kishore, Nair Nirmala, Gope Rajkumar, Rath Shibanand, Prost Audrey
Ekjut, Ward Number 17, Plot 556B, Potka, District-West Singhbhum, PO-Chakradharpur, Jharkhand 833102 India.
UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK.
Cost Eff Resour Alloc. 2017 Mar 21;15:2. doi: 10.1186/s12962-017-0064-9. eCollection 2017.
Neonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women's groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention.
Costs were estimated from the provider's perspective and calculated separately for the women's group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted.
The incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India's Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective.
Participatory learning and action with women's groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.
在包括印度在内的许多低收入和中等收入国家，新生儿死亡率仍然高得令人无法接受。开展了一项社区动员干预措施，通过经认证的社会健康活动家（ASHA）推动的妇女团体参与式学习和行动，以改善孕产妇和新生儿健康。该干预措施在印度东部的贾坎德邦和奥里萨邦通过一项整群随机对照试验进行了评估。本研究旨在评估该干预措施的成本效益。
从提供者的角度估算成本，并分别计算妇女团体干预措施以及在所有试验地区开展的加强乡村卫生与营养委员会（VHNSC）活动的成本。成本按2017年价格估算，并换算成美元（USD）。计算相对于不作为替代方案的增量成本效益比（ICER），并与世界卫生组织（WHO）具有成本效益的干预措施阈值进行比较。计算了避免新生儿死亡和伤残调整生命年（DALY）情况下的ICER。
每避免一个DALY的干预增量成本为83美元（包括加强VHNSC的成本在内为99美元），每避免一例新生儿死亡的增量成本为2545美元（包括加强VHNSC的成本在内为3046美元）。根据WHO阈值，该干预措施具有很高的成本效益，因为每挽救的生命年或避免的DALY成本低于印度人均国内生产总值（GDP）。使用一系列单向敏感性分析测试了研究结果对假设的稳健性。敏感性分析并未改变该干预措施具有很高成本效益的结论。
由ASHA推动的妇女团体参与式学习和行动对于降低识字率低且新生儿死亡率高的农村地区的新生儿死亡率具有很高的成本效益。这种方法可以有效地补充印度基于机构的护理，并且可以在类似的高死亡率环境中扩大规模。
