Alfonso Y Natalia, Hyder Adnan A, Alonge Olakunle, Salam Shumona Sharmin, Baset Kamran, Rahman Aminur, Hoque Dewan Md Emdadul, Islam Md Irteja, Rahman Fazlur, El-Arifeen Shams, Bishai David
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Inj Epidemiol. 2021 Oct 29;8(1):61. doi: 10.1186/s40621-021-00351-9.
Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche (daycare) intervention in preventing child drowning.
The cost of the crèches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the crèches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective.
From the program perspective the annual operating cost of a crèche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was - $166,833 (95% CI: - $197,421 to - $141,341)-meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the crèche intervention was cost-effective even when the societal economic benefits were ignored.
Based on the evidence, the crèche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable.
溺水是孟加拉国农村地区12至59个月大儿童的主要死因。本研究评估了大规模日托所干预措施预防儿童溺水的成本效益。
采用基于构成要素的方法评估日托所干预措施的成本，并根据在不同研究区域实施干预措施的两个机构在整个研究期间前瞻性收集的月度支出数据进行评估。日托所干预措施有效性的估计基于先前的一项研究。该研究从项目和社会两个角度评估了成本效益。
从项目角度来看，一个日托所的年度运营成本为416.35美元（95%置信区间：221美元至576美元），每个儿童的年度成本为16美元（95%置信区间：8美元至23美元），通过日托所干预措施每挽救一条生命的增量成本效益比（ICER）为17,008美元（95%置信区间：8817美元至24,619美元）。从社会角度（包括父母的时间价值）来看，每挽救一条生命的ICER为 - 166,833美元（95%置信区间： - 197,421美元至 - 141,341美元），这意味着日托所为每个入托儿童带来了净经济效益。从社会角度（不包括父母的时间）来看，根据每避免一个伤残调整生命年的ICER为1978美元，即使忽略社会经济效益，日托所干预措施也是具有成本效益的。
基于现有证据，日托所干预措施有很大潜力通过以合理的项目成本减少儿童溺水来产生净社会经济效益。
