Haghparast-Bidgoli Hassan, Ojha Amit, Gope Rajkumar, Rath Shibanand, Pradhan Hemanta, Rath Suchitra, Kumar Amit, Nath Vikash, Basu Parabita, Copas Andrew, Houweling Tanja A J, Minz Akay, Baskey Pradeep, Ahmed Manir, Chakravarthy Vasudha, Mahanta Riza, Palmer Tom, Skordis Jolene, Nair Nirmala, Tripathy Prasanta, Prost Audrey
Institute for Global Health, University College London, London, United Kingdom.
Ekjut, Chakradharpur, Jharkhand, India.
PLOS Glob Public Health. 2023 Jun 29;3(6):e0001128. doi: 10.1371/journal.pgph.0001128. eCollection 2023.
An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women's groups intervention scaled up by the public health system in Jharkhand, eastern India. The intervention was evaluated through a pragmatic cluster non-randomised controlled trial in six districts. We estimated the cost of the intervention at scale from a provider perspective, with a 42-month time horizon for 20 districts. We estimated costs using a combination of top-down and bottom-up approaches. All costs were adjusted for inflation, discounted at 3% per year, and converted to 2020 International Dollars (INT$). Incremental cost-effectiveness ratios (ICERs) were estimated using extrapolated effect sizes for the impact of the intervention in 20 districts, in terms of cost per neonatal deaths averted and cost per life year saved. We assessed the impact of uncertainty on results through one-way and probabilistic sensitivity analyses. We also estimated benefit-cost ratio using a benefit transfer approach. Total intervention costs for 20 districts were INT$ 15,017,396. The intervention covered an estimated 1.6 million livebirths across 20 districts, translating to INT$ 9.4 per livebirth covered. ICERs were estimated at INT$ 1,272 per neonatal death averted or INT$ 41 per life year saved. Net benefit estimates ranged from INT$ 1,046 million to INT$ 3,254 million, and benefit-cost ratios from 71 to 218. Our study suggests that participatory women's groups scaled up by the Indian public health system were highly cost-effective in improving neonatal survival and had a very favourable return on investment. The intervention can be scaled up in similar settings within India and other countries.
据估计，2020年有240万新生儿死亡，其中80%发生在撒哈拉以南非洲和南亚。为实现降低新生儿死亡率的可持续发展目标，高死亡率国家需要大规模实施基于证据且具有成本效益的干预措施。我们的研究旨在估计印度东部贾坎德邦由公共卫生系统扩大规模实施的参与式妇女团体干预措施的成本、成本效益和效益成本比。该干预措施通过在六个地区进行的实用整群非随机对照试验进行评估。我们从提供者的角度估计了扩大规模后的干预措施成本，以20个地区为期42个月的时间范围。我们使用自上而下和自下而上相结合的方法估计成本。所有成本都进行了通货膨胀调整，按每年3%进行贴现，并换算为2020年国际美元（INT$）。使用对20个地区干预措施影响的外推效应大小，以避免每例新生儿死亡的成本和每挽救一个生命年的成本来估计增量成本效益比（ICER）。我们通过单因素和概率敏感性分析评估不确定性对结果的影响。我们还使用效益转移方法估计效益成本比。20个地区的干预总成本为15,017,396国际美元。该干预措施覆盖了20个地区约160万例活产，即每例覆盖的活产成本为9.4国际美元。估计的ICER为避免每例新生儿死亡1272国际美元或每挽救一个生命年41国际美元。净效益估计范围为1.046亿国际美元至3.254亿国际美元，效益成本比为71至218。我们的研究表明，印度公共卫生系统扩大规模的参与式妇女团体在提高新生儿存活率方面具有很高的成本效益，且投资回报率非常可观。该干预措施可在印度和其他国家的类似环境中扩大规模实施。
