Escribano Ferrer Blanca, Hansen Kristian Schultz, Gyapong Margaret, Bruce Jane, Narh Bana Solomon A, Narh Clement T, Allotey Naa-Korkor, Glover Roland, Azantilow Naa-Charity, Bart-Plange Constance, Sagoe-Moses Isabella, Webster Jayne
Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK.
Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana.
Malar J. 2017 Jul 5;16(1):277. doi: 10.1186/s12936-017-1906-9.
Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions.
A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey.
Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region.
Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.
加纳制定了两项主要的社区策略，旨在增加获得疟疾、腹泻和疑似肺炎优质治疗的机会：综合社区病例管理（iCCM）和基于社区的卫生规划与服务（CHPS）。本研究的目的是评估这些策略在项目实施条件下的成本效益。
进行了成本效益分析。采用的有效性指标是给予适当的诊断和治疗。适当的诊断和治疗数据分别来自加纳沃尔特和北部地区实施iCCM后2年和8年进行的家庭调查。研究人群为在访谈前两周内有发热、腹泻和/或咳嗽症状的5岁以下儿童的照料者。成本数据主要来自国家疟疾控制项目（NMCP）、卫生部、CHPS机构以及一项家庭调查。
在沃尔特地区，即使在调整了不同的贴现率、机构成本以及iCCM和CHPS的利用率之后，iCCM模式下对疟疾、腹泻和疑似肺炎进行适当的诊断和治疗比CHPS更具成本效益，但当iCCM的适当治疗减少50%时则不然。由于北部地区前往社区卫生行动（CBA）的照料者数量较少，因此无法在该地区进行成本效益分析。然而，成本分析表明，与沃尔特地区以及北部地区的CHPS策略相比，北部地区的iCCM模式在诊断和治疗每例疟疾、腹泻和疑似肺炎病例时成本更高。
对于沃尔特地区5岁以下儿童的照料者而言，综合社区病例管理在治疗疟疾、腹泻和疑似肺炎方面比CHPS更具成本效益。需要对北部地区的iCCM策略进行修订，以提高其成本效益。应探索长期融资策略，包括可能纳入国家健康保险计划（NHIS）福利套餐。应开展关于将iCCM纳入NHIS的可接受性研究。
