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Sökning: onr:"swepub:oai:DiVA.org:umu-117032" > Cost-effectiveness ...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005594naa a2200577 4500
001oai:DiVA.org:umu-117032
003SwePub
008160218s2015 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1170322 URI
0247 a 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
1001 a 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 c 2015-01-10
264 1b BioMed Central (BMC),c 2015
338 a electronic2 rdacarrier
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 MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskapx Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi0 (SwePub)303022 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciencesx Public Health, Global Health, Social Medicine and Epidemiology0 (SwePub)303022 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
7001 a Pulkki-Brännström, Anni-Maria,d 1983-u Umeå universitet,Epidemiologi och global hälsa,UCL Institute for Global Health, London, UK4 aut0 (Swepub:umu)anpu0004
7001 a Nambiar, Bejoyu UCL Institute for Global Health, London, UK4 aut
7001 a Kim, Sungwooku UCL Institute for Global Health, London, UK4 aut
7001 a Bondo, Austinu Capital City, Lilongwe 3, Malawi4 aut
7001 a Banda, Lumbaniu Capital City, Lilongwe 3, Malawi4 aut
7001 a Makwenda, Charlesu Capital City, Lilongwe 3, Malawi4 aut
7001 a Batura, Nehau UCL Institute for Global Health, London, UK4 aut
7001 a Haghparast-Bidgoli, Hassanu UCL Institute for Global Health, London, UK4 aut
7001 a Hunter, Rachaelu London, UK4 aut
7001 a Costello, Anthonyu UCL Institute for Global Health, London, UK4 aut
7001 a Baio, Gianlucau London, UK4 aut
7001 a Skordis-Worrall, Joleneu UCL Institute for Global Health, London, UK4 aut
7102 a UCL Institute for Global Health, London, UKb Epidemiologi och global hälsa4 org
7730 t Cost Effectiveness and Resource Allocationd : BioMed Central (BMC)g 13q 13x 1478-7547
8564 u https://doi.org/10.1186/s12962-014-0028-2y Fulltext
8564 u https://umu.diva-portal.org/smash/get/diva2:904142/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 u https://resource-allocation.biomedcentral.com/track/pdf/10.1186/s12962-014-0028-2
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-117032
8564 8u https://doi.org/10.1186/s12962-014-0028-2

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