越南促进儿童早期发展：一项集群随机试验的成本效益分析。

Promoting early childhood development in Viet Nam: cost-effectiveness analysis alongside a cluster-randomised trial.

机构信息

School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.

出版信息

Lancet Glob Health. 2023 Aug;11(8):e1269-e1276. doi: 10.1016/S2214-109X(23)00271-1.

DOI:10.1016/S2214-109X(23)00271-1

PMID:37474233

Abstract

BACKGROUND

Economic evaluations are critical to ensure effective resource use to implement and scale up child development interventions. This study aimed to estimate the cost-effectiveness of a multicomponent early childhood development intervention in rural Viet Nam.

METHODS

We did a cost-effectiveness study alongside a cluster-randomised trial with a 30-month time horizon. The study included 669 mothers from 42 communes in the intervention group, and 576 mothers from 42 communes in the control group. Mothers in the intervention group attended Learning Clubs sessions from mid-pregnancy to 12 months after delivery. The primary outcomes were child cognitive, language, motor, and social-emotional development at age 2 years. In this analysis, we estimated the incremental cost-effectiveness ratios (ICERs) of the intervention compared with the usual standard of care from the service provider and household perspectives. We used non-parametric bootstrapping to examine uncertainty, and applied a 3% discount rate.

FINDINGS

The total intervention cost was US$169 898 (start-up cost $133 692 and recurrent cost $36 206). The recurrent cost per child was $58 (1 341 741 Vietnamese dong). Considering the recurrent cost alone, the base-case ICER was $14 and mean ICER of 1000 bootstrap samples was $14 (95% CI -0·48 to 30) per cognitive development score gained with a 3% discount rate to costs. The ICER per language and motor development score gained was $22 and $20, respectively, with a 3% discount rate to costs.

INTERPRETATION

The intervention was cost-effective: the ICER per child cognitive development score gained was 0·5% of Viet Nam's gross domestic product per capita, alongside other benefits in language and motor development. This finding supports the scaling up of this intervention in similar socioeconomic settings.

FUNDING

Australian National Health and Medical Research Council and Grand Challenges Canada.

TRANSLATION

For the Vietnamese translation of the abstract see Supplementary Materials section.

摘要

背景

经济评估对于确保有效利用资源以实施和扩大儿童发展干预措施至关重要。本研究旨在评估越南农村一项多组分儿童早期发展干预措施的成本效益。

方法

我们在一项为期 30 个月的群组随机试验的同时进行了一项成本效益研究。该研究纳入了来自干预组 42 个村庄的 669 位母亲和对照组 42 个村庄的 576 位母亲。干预组的母亲从中孕期到分娩后 12 个月参加学习俱乐部课程。主要结局为儿童在 2 岁时的认知、语言、运动和社会情感发育。在本分析中，我们从服务提供者和家庭角度估计了干预措施与常规标准护理相比的增量成本效益比（ICER）。我们使用非参数引导法来检查不确定性，并应用 3%的贴现率。

发现

干预总费用为 169898 美元（启动成本 133692 美元，经常性成本 36206 美元）。每个儿童的经常性费用为 58 美元（1341741 越南盾）。仅考虑经常性成本，基础案例的 ICER 为 14，1000 次引导样本的平均 ICER 为 14（95%CI-0·48 至 30），每获得 1 分认知发育评分，成本贴现率为 3%。每获得 1 分语言和运动发育评分的 ICER 分别为 22 美元和 20 美元，成本贴现率为 3%。