Cost and effectiveness analysis of Kangaroo mother care and conventional care method in low birth weight neonates in Tabriz 2010-2011

Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review

This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.

Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India

AIM

To estimate incremental costs of an implementation model for scaling up Kangaroo Mother Care (KMC) for neonates with birthweight <2000 g.

METHODS

Seven sites across Ethiopia and India collected data for 2018-19 to calculate incremental recurrent costs (of health worker time, supplies, and operations) and start-up costs for KMC scale up. The costs were estimated per live newborn <2000 g eligible for KMC identified in the study population.

RESULTS

Scaling up KMC in study districts required average incremental costs of US$59 (95% CI US$ 52-67) in Ethiopia and US$72 (95% CI US$ 41-103) in India per eligible newborn in the population. Most of these costs were recurrent; the annualised start-up costs per eligible newborn ranged from 12%-25% of total costs in Ethiopia and 9%-16% in India. The major cost driver was human resources, followed by initial and recurrent training, supplies, and communications costs. Incremental infrastructure costs were only 2%-6% of total costs in both countries. Most of the costs were for activities at the KMC implementing facility, accounting for 79%-88% of the total costs in Ethiopia and 89%-93% of those in India.

CONCLUSION

The costs for successful scale up of KMC seem affordable but must be included in programme budgets.

Making neonatal intensive care: cost effective

With the improvement in neonatal care in last two decades, the survival of very low birth weight (VLBW), extremely low birth weight (ELBW), fetus diagnosed with malformations, and congenital heart disease and severe birth asphyxia has increased significantly. These infants when admitted to the neonatal intensive care unit (NICU) need numerous interventions depending upon the severity of sickness and postnatal course like need of mechanical ventilation (MV) or noninvasive ventilation, surfactant administration, placement of central lines, total parenteral nutrition, and numerous medications. The duration of NICU and hospital stay of these high-risk infants varies from few days to few weeks to few months. Long stay in the hospital leads to high hospital bills and increase the cost of neonatal care substantially. The cost of NICU stay varies from 90 USD to 1250-2500 USD per day as per various studies, depending upon the level of care and sickness of the admitted infants. In developed countries, the burden of NICU cost is often taken care by the government or insurance companies but in many developing countries the parents bear the substantial cost of NICU admission of their infants. There are many interventions which when implemented in the NICU will lead to reduction of the cost and will make the NICU cost effective. In this review, we cover various interventions mostly from our own published work which have shown to reduce the NICU cost and make it more cost effective with equivalent and better neonatal outcomes, especially in developing countries like ours.

To compare cost effectiveness of 'Kangaroo Ward Care' with 'Intermediate intensive care' in stable very low birth weight infants (birth weight < 1100 grams): a randomized control trial

BACKGROUND

To compare cost effectiveness of 'Kangaroo Ward Care' with 'Intermediate Intensive Care' in stable very low birth weight infants (birth weight < 1100 g).

METHODS

This is the secondary analysis of the study in which we have analysed the cost effectiveness of 'Kangaroo ward care' (KWC) with 'Intermediate Intensive Care' (IIC). In this randomized control trial 141 infants (less than 1100 g and ≤ 32 weeks at birth) were enrolled, 71 were randomized to KWC group and 70 to IIC group, once the infant reached a weight of 1150 g. Infants randomized to KWC group were shifted to the Kangaroo ward immediately after randomization. Infants randomized to IIC group were shifted to the Kangaroo ward once the infant reached 1250 g.

RESULTS

Cost incurred by the patient in both the groups from the time of randomization to hospital discharge was calculated. The hospital costs were determined by "top-down" accounting methods and out of pocket expenditure of parents from standard "bottom-up" cost-accounting methods. There was significant reduction in neonatal charges in KWC group post-randomization {41591.9 ± 21712.8 INR vs 75388.8 ± 25532.2 INR; p < 0.001}). The separate "top-down" and "bottom-up" cost analysis showed that there was significant reduction of hospital and parents expenditure in KWC group when compared to IIC group (p < 0.001). There was significant saving of around 33800 INR (USD) in the KWC group for each patient.

CONCLUSION

Initiating early shifting to Kangaroo ward is cost effective intervention and have huge monetary implication in resource poor countries. (CTRI/2014/05/004625, retrospectively registered, Registered on: 26/05/2014).

CLINICAL TRIAL REGISTRATION

Clinical trial registry of India CTRI/2014/05/004625 ( http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=7640&EncHid=&userName=CTRI/2014/05/004625 ) Registered on: 26/05/2014. Date of enrolment of the first participant to the trial: 13/11/2013.