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. 2021 Oct 29;8(1):61.
doi: 10.1186/s40621-021-00351-9.

Cost-effectiveness analysis of a large-scale crèche intervention to prevent child drowning in rural Bangladesh

Y Natalia Alfonso  1 , Adnan A Hyder  2 , Olakunle Alonge  3 , Shumona Sharmin Salam  4 , Kamran Baset  5 , Aminur Rahman  5 , Dewan Md Emdadul Hoque  6 , Md Irteja Islam  6 , Fazlur Rahman  5 , Shams El-Arifeen  6 , David Bishai  7
Affiliations

Cost-effectiveness analysis of a large-scale crèche intervention to prevent child drowning in rural Bangladesh

Y Natalia Alfonso et al. Inj Epidemiol. .

Abstract

Background: Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche (daycare) intervention in preventing child drowning.

Methods: The cost of the crèches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the crèches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective.

Results: From the program perspective the annual operating cost of a crèche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was - $166,833 (95% CI: - $197,421 to - $141,341)-meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the crèche intervention was cost-effective even when the societal economic benefits were ignored.

Conclusions: Based on the evidence, the crèche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable.

Keywords: Bangladesh; Child health; Children; Cost-effectiveness; Crèche; Drowning; Injury; Mortality; Prevention.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Proportional distribution of crèche program costs
Fig. 2
Fig. 2
Sensitivity analysis of the effect of changes to program parameters on the ICER. Note: An example of how to interpret this graph is, when the monthly minimum wage rate increased by $16.49 (1 standard deviation), the ICER per live saved cost savings increased approximately by 7%, or when the number of lives saved increased by 7.85 lives (1 standard deviation), the ICER per live saved cost savings decreased approximately by 6%
Fig. 3
Fig. 3
Effect of proportional changes to the program parameters on the ICER
See this image and copyright information in PMC

References

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    1. Alonge O, Bishai D, Wadhwaniya S, et al. Large-scale evaluation of interventions designed to reduce childhood Drownings in rural Bangladesh: a before and after cohort study. Inj Epidemiol. 2020;7:1–12. doi: 10.1186/s40621-020-00245-2. - DOI - PMC - PubMed
    1. Bishai DM, Hyder AA. Modeling the cost effectiveness of injury interventions in lower and middle income countries: opportunities and challenges. Cost Eff Resour Alloc. 2006;4:2–11. doi: 10.1186/1478-7547-4-2. - DOI - PMC - PubMed
    1. Bloomberg MR. Ending the Drowning Epidemic. Project Syndicate. Aug 12, 2021, 2021.

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