Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
Trop Med Int Health
; 17(8): 951-7, 2012 Aug.
Article
em En
| MEDLINE
| ID: mdl-22643324
ABSTRACT
OBJECTIVE:
To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana - treatment using antimalarials only (artesunate-amodiaquine - AAQ) and combined treatment using antimalarials and antibiotics (artesunate-amodiaquine plus amoxicillin - AAQ + AMX).METHODS:
We assessed the costs and cost-effectiveness of AAQ and AAQ + AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step-wedged design. Approximately, 12,000 children aged 2-59 months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under-five deaths averted and disability-adjusted life years (DALYs) averted as effectiveness measures.RESULTS:
Total economic costs for the interventions were US$ 204,394.72 (AAQ) and US$ 260,931.49 (AAQ + AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ + AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ + AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ + AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ + AMX).CONCLUSION:
Both AAQ and AAQ + AMX approaches were cost-effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost-effective. Home management of under-five fevers in rural settings is cost-effective in reducing under-five mortality.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Autocuidado
/
Febre
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Antibacterianos
/
Antimaláricos
Tipo de estudo:
Clinical_trials
/
Health_economic_evaluation
Limite:
Child, preschool
/
Female
/
Humans
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Infant
/
Male
País/Região como assunto:
Africa
Idioma:
En
Revista:
Trop Med Int Health
Assunto da revista:
MEDICINA TROPICAL
/
SAUDE PUBLICA
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Gana