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Randomized Controlled Trial
. 2015 Nov 30;10(11):e0142718.
doi: 10.1371/journal.pone.0142718. eCollection 2015.

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

Lumbwe Chola  1   2   3 , Lars T Fadnes  3   4 , Ingunn M S Engebretsen  3   4 , Lungiswa Nkonki  5 , Victoria Nankabirwa  3   6 , Halvor Sommerfelt  3   7 , James K Tumwine  6 , Thorkild Tylleskar  3 , Bjarne Robberstad  3 ; PROMISE-EBF Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Lumbwe Chola et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Uganda PROMISE-EBF trial profile.
Fig 2
Fig 2. Decision model of cost-effectiveness analysis for peer counselling vs HFP.
Fig 3
Fig 3. Tornado diagram of one-way sensitivity analyses results of uncertain model parameters.
EV = expected value. Net health benefits = ((Effectiveness–Costs)/Willingness to pay).
Fig 4
Fig 4. Cost-effectiveness scatterplot and acceptability curves for peer counselling vs HFP (Cost/MEBF).
Fig 5
Fig 5. Cost-effectiveness scatterplot and acceptability curves for peer counselling vs HFP (Cost/DALY).
See this image and copyright information in PMC

References

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