Rudgard William E, Obiesie Sopuruchukwu, Desmond Chris, Casale Marisa, Cluver Lucie
Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
PLOS Glob Public Health. 2023 Aug 17;3(8):e0001666. doi: 10.1371/journal.pgph.0001666. eCollection 2023.
There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.
在低收入和中等收入国家，关于减少针对儿童暴力行为干预措施的成本效益的证据有限。我们使用决策分析模型来评估南非姆普马兰加省减少青少年情感、身体和性虐待的三种干预方案的成本效益。干预方案如下：1）社区赠款外展，将符合条件但未领取南非儿童抚养津贴（CSG）的家庭联系起来；2）基于小组的育儿支持；3）基于小组的育儿支持“加”与CSG的联系。我们估计了十年时间范围内干预方案的平均成本效益比（ACER），并将其与南非特定的支付意愿（WTP）阈值（3390美元）进行比较。健康影响以避免的伤残调整生命年（DALY）表示。我们的模型考虑了常规服务成本与基于试验成本的四种组合，以及暴力行为的人群平均发生率与高发生率。在常规服务成本计算下，考虑暴力行为的人群平均发生率时，赠款外展和育儿支持的ACER低于WTP阈值，分别为每避免一个DALY 2850美元（下限：1840美元 - 上限：10500美元）和2620美元（1520美元 - 9800美元）；考虑暴力行为的高发生率时，分别为每避免一个DALY 1320美元（908美元 - 5180美元）和1340美元（758美元 - 4910美元）。相对于单独的育儿支持，育儿支持加赠款联系的增量成本效益在暴力行为的人群平均发生率和高发生率下，分别为每避免一个DALY 462美元（346美元 - 1610美元）和225美元（150美元 - 811美元）。在基于试验成本计算下，考虑暴力行为的高发生率时，只有赠款外展的ACER低于WTP阈值，为每避免一个DALY 2580美元（1640美元 - 9370美元）。所有ACER的置信区间都超过了WTP阈值。总之，如果采用常规服务成本计算并覆盖高风险群体，赠款外展和育儿支持可能是减少针对青少年暴力行为的具有成本效益的干预方案。将育儿支持与赠款联系相结合可能比单独的育儿支持更具成本效益。
