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LIBRIS Formathandbok  (Information om MARC21)
00005658naa a2200601 4500
008160218s2015 | |||||||||||000 ||eng|
024a urn:nbn:se:umu:diva-1170322 urn
024a https://doi.org/10.1186/s12962-014-0028-22 DOI
040 a (SwePub)umu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
100a Colbourn, Timu UCL Institute for Global Health, London, UK4 aut
2451 0a Cost-effectiveness and affordability of community mobilisation through women's groups and quality improvement in health facilities (MaiKhanda trial) in Malawi
264 1b BioMed Central,c 2015
338 a electronic2 rdacarrier
506 a gratis
506 a gratis
520 a BACKGROUND: Understanding the cost-effectiveness and affordability of interventions to reduce maternal and newborn deaths is critical to persuading policymakers and donors to implement at scale. The effectiveness of community mobilisation through women's groups and health facility quality improvement, both aiming to reduce maternal and neonatal mortality, was assessed by a cluster randomised controlled trial conducted in rural Malawi in 2008-2010. In this paper, we calculate intervention cost-effectiveness and model the affordability of the interventions at scale.METHODS: Bayesian methods are used to estimate the incremental cost-effectiveness of the community and facility interventions on their own (CI, FI), and together (FICI), compared to current practice in rural Malawi. Effects are estimated with Monte Carlo simulation using the combined full probability distributions of intervention effects on stillbirths, neonatal deaths and maternal deaths. Cost data was collected prospectively from a provider perspective using an ingredients approach and disaggregated at the intervention (not cluster or individual) level. Expected Incremental Benefit, Cost-effectiveness Acceptability Curves and Expected Value of Information (EVI) were calculated using a threshold of $780 per disability-adjusted life-year (DALY) averted, the per capita gross domestic product of Malawi in 2013 international $.RESULTS: The incremental cost-effectiveness of CI, FI, and combined FICI was $79, $281, and $146 per DALY averted respectively, compared to current practice. FI is dominated by CI and FICI. Taking into account uncertainty, both CI and combined FICI are highly likely to be cost effective (probability 98% and 93%, EVI $210,423 and $598,177 respectively). Combined FICI is incrementally cost effective compared to either intervention individually (probability 60%, ICER $292, EIB $9,334,580 compared to CI). Future scenarios also found FICI to be the optimal decision. Scaling-up to the whole of Malawi, CI is of greatest value for money, potentially averting 13.0% of remaining annual DALYs from stillbirths, neonatal and maternal deaths for the equivalent of 6.8% of current annual expenditure on maternal and neonatal health in Malawi.CONCLUSIONS: Community mobilisation through women's groups is a highly cost-effective and affordable strategy to reduce maternal and neonatal mortality in Malawi. Combining community mobilisation with health facility quality improvement is more effective, more costly, but also highly cost-effective and potentially affordable in this context.
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciencesx Public Health, Global Health, Social Medicine and Epidemiology0 (SwePub)303022 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskaperx Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi0 (SwePub)303022 hsv//swe
650 7a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskaper0 (SwePub)3032 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciences0 (SwePub)3032 hsv//eng
653 a Cost-effectiveness
653 a Affordability
653 a Community mobilisation
653 a Women's groups
653 a Quality improvement
653 a MaiKhanda
653 a Scale-up
653 a Future scenarios
653 a Malawi
700a Pulkki-Brännström, Anni-Maria,d 1983-u Umeå universitet,Epidemiologi och global hälsa,UCL Institute for Global Health, London, UK4 aut0 (Swepub:umu)anpu0004
700a Nambiar, Bejoyu UCL Institute for Global Health, London, UK4 aut
700a Kim, Sungwooku UCL Institute for Global Health, London, UK4 aut
700a Bondo, Austinu Capital City, Lilongwe 3, Malawi4 aut
700a Banda, Lumbaniu Capital City, Lilongwe 3, Malawi4 aut
700a Makwenda, Charlesu Capital City, Lilongwe 3, Malawi4 aut
700a Batura, Nehau UCL Institute for Global Health, London, UK4 aut
700a Haghparast-Bidgoli, Hassanu UCL Institute for Global Health, London, UK4 aut
700a Hunter, Rachaelu London, UK4 aut
700a Costello, Anthonyu UCL Institute for Global Health, London, UK4 aut
700a Baio, Gianlucau London, UK4 aut
700a Skordis-Worrall, Joleneu UCL Institute for Global Health, London, UK4 aut
710a UCL Institute for Global Health, London, UKb Epidemiologi och global hälsa4 org
773t Cost Effectiveness and Resource Allocationd : BioMed Centralg 13q 13x 1478-7547x 1478-7547
856u https://doi.org/10.1186/s12962-014-0028-2
856u http://umu.diva-portal.org/smash/get/diva2:904142/FULLTEXT01.pdf
8564 8u http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-117032x lärosäteslänky Till lärosätets (umu) databas
8564 8u https://doi.org/10.1186/s12962-014-0028-2

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