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Bone JN, Khowaja AR, Vidler M, Payne BA, Bellad MB, Goudar SS, Mallapur AA, Munguambe K, Qureshi RN, Sacoor C, Sevene E, Frederix GWJ, Bhutta ZA, Mitton C, Magee LA, von Dadelszen P. Economic and cost-effectiveness analysis of the Community-Level Interventions for Pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique. BMJ Glob Health 2021; 6:bmjgh-2020-004123. [PMID: 34031134 PMCID: PMC8149358 DOI: 10.1136/bmjgh-2020-004123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014–2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency. Methods Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1–3, 4–7, ≥8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision tree model was built to determine the cost-effectiveness of the intervention (vs usual care), based on the primary clinical endpoint of years of life lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes. Results The incremental per pregnancy cost of the intervention was US$12.66 (India), US$11.51 (Pakistan) and US$13.26 (Mozambique). As implemented, the intervention was not cost-effective due largely to minimal differences in YLL between arms. However, among women who received ≥8 CLIP contacts (four in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries). Conclusion The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting WHO guidance on antenatal contact frequency. Trial registration number NCT01911494.
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Affiliation(s)
- Jeffrey N Bone
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Asif R Khowaja
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth A Payne
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mrutyunjaya B Bellad
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Ashalata A Mallapur
- S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - Khatia Munguambe
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
| | - Rahat N Qureshi
- Centre of Excellence, Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique
| | - Esperanca Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique.,Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Zulfiqar A Bhutta
- Centre of Excellence, Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Craig Mitton
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada .,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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