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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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Related in: MedlinePlus

Tornado diagram of one-way sensitivity analyses results of uncertain model parameters.EV = expected value. Net health benefits = ((Effectiveness–Costs)/Willingness to pay).
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pone.0142718.g003: Tornado diagram of one-way sensitivity analyses results of uncertain model parameters.EV = expected value. Net health benefits = ((Effectiveness–Costs)/Willingness to pay).

Mentions: As shown in the tornado diagram in Fig 3, the mortality rate in the intervention group had the greatest impact, accounting for 49% of the uncertainty, followed by life expectancy (21%), and cost of treating severe diarrhoea (18%). A further 10% of the variation was accounted for by the discount rate (9%) and the cost of treating moderate diarrhoea (1%). Varying the other parameters had little impact on cost-effectiveness.


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)

Tornado diagram of one-way sensitivity analyses results of uncertain model parameters.EV = expected value. Net health benefits = ((Effectiveness–Costs)/Willingness to pay).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0142718.g003: Tornado diagram of one-way sensitivity analyses results of uncertain model parameters.EV = expected value. Net health benefits = ((Effectiveness–Costs)/Willingness to pay).
Mentions: As shown in the tornado diagram in Fig 3, the mortality rate in the intervention group had the greatest impact, accounting for 49% of the uncertainty, followed by life expectancy (21%), and cost of treating severe diarrhoea (18%). A further 10% of the variation was accounted for by the discount rate (9%) and the cost of treating moderate diarrhoea (1%). Varying the other parameters had little impact on cost-effectiveness.

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