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Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda.

Chola L, Fadnes LT, Engebretsen IM, Nkonki L, Nankabirwa V, Sommerfelt H, Tumwine JK, Tylleskar T, Robberstad B, PROMISE-EBF Study Gro - PLoS ONE (2015)

Bottom Line: However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa.Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted.However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

View Article: PubMed Central - PubMed

Affiliation: Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Pretoria, South Africa.

ABSTRACT

Background: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.

Methods: Data were obtained from a community randomized trial conducted in Uganda between 2006-2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.

Findings: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses.

Conclusions: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda's GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

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Decision model of cost-effectiveness analysis for peer counselling vs HFP.
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pone.0142718.g002: Decision model of cost-effectiveness analysis for peer counselling vs HFP.

Mentions: A decision tree with a state Markov model was used to depict breastfeeding promotion and the associated feeding patterns in the first six months of life (Fig 2). The model predicts feeding patterns and children can have one of two options: exclusive or predominant breastfeeding (EBF/PBF) and mixed or replacement feeding (MF/RF), see Box 1 for definitions. The merging of EBF and PBF was done because few studies indicate clear differences in health outcomes between EBF and PBF [11, 27]. MF and RF were merged because only 0.3% of the children in the PROMISE-EBF trial received replacement feeding. In the model, children were allowed to move both ways between feeding states. This was done to reflect the findings of the PROMISE-EBF trial, which showed that mothers tended to periodically switch between EBF/PBF and MF [28]. This might be the case, since the definition of EBF/PBF was based on shorter periods (24-hours and 1-week recall), which may allow for more frequent fluctuations and may under-represent usual practice [29].


Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda.

Chola L, Fadnes LT, Engebretsen IM, Nkonki L, Nankabirwa V, Sommerfelt H, Tumwine JK, Tylleskar T, Robberstad B, PROMISE-EBF Study Gro - PLoS ONE (2015)

Decision model of cost-effectiveness analysis for peer counselling vs HFP.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664391&req=5

pone.0142718.g002: Decision model of cost-effectiveness analysis for peer counselling vs HFP.
Mentions: A decision tree with a state Markov model was used to depict breastfeeding promotion and the associated feeding patterns in the first six months of life (Fig 2). The model predicts feeding patterns and children can have one of two options: exclusive or predominant breastfeeding (EBF/PBF) and mixed or replacement feeding (MF/RF), see Box 1 for definitions. The merging of EBF and PBF was done because few studies indicate clear differences in health outcomes between EBF and PBF [11, 27]. MF and RF were merged because only 0.3% of the children in the PROMISE-EBF trial received replacement feeding. In the model, children were allowed to move both ways between feeding states. This was done to reflect the findings of the PROMISE-EBF trial, which showed that mothers tended to periodically switch between EBF/PBF and MF [28]. This might be the case, since the definition of EBF/PBF was based on shorter periods (24-hours and 1-week recall), which may allow for more frequent fluctuations and may under-represent usual practice [29].

Bottom Line: However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa.Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted.However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

View Article: PubMed Central - PubMed

Affiliation: Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Pretoria, South Africa.

ABSTRACT

Background: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.

Methods: Data were obtained from a community randomized trial conducted in Uganda between 2006-2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.

Findings: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses.

Conclusions: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda's GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.

Show MeSH
Related in: MedlinePlus