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Randomized Controlled Trial
. 2024 Dec 27;9(12):e014940.
doi: 10.1136/bmjgh-2023-014940.

Cost-effectiveness analysis of proactive home visits compared with site-based community health worker care on antenatal care outcomes in Mali: a cluster-randomised trial

Osondu Ogbuoji  1   2 , Minahil Shahid  3 , Armand Zimmerman  3 , Jenny X Liu  4 , Kassoum Kayentao  5   6 , Caroline Whidden  6   7 , Emily Treleaven  8 , Coumba Traoré  6 , Mahamadou Sogoba  6 , Saibou Doumbia  6 , David Charles Boettiger  4   9 , Amadou Beydi Cissé  6 , Youssouf Keita  6 , Mohamed Berthé  10 , Ari Johnson  6   11
Affiliations
Randomized Controlled Trial

Cost-effectiveness analysis of proactive home visits compared with site-based community health worker care on antenatal care outcomes in Mali: a cluster-randomised trial

Osondu Ogbuoji et al. BMJ Glob Health. .

Abstract

Introduction: Despite recommendations from the WHO, antenatal care (ANC) coverage remains low in many low-income and middle-income countries (LMICs). Community health workers (CHWs) can play an important role in expanding ANC coverage through pregnancy identification, provision of health education, screening for complications, delivery of therapeutic care and referral to higher levels of care. However, despite the success of CHW programmes in various countries, WHO has called for additional research to develop evidence-based models that optimise CHW service delivery and that can be replicated across geographies.

Methods: The ProCCM Trial was a cluster-randomised controlled trial to compare proactive home visits by CHWs (intervention, 69 village clusters) to the provision of CHW care at community fixed sites only (control, 68 village clusters) in the Bankass health district in Central Mali. In this study, we conducted a cost-effectiveness analysis of proactive CHW home visits in improving ANC utilisation, a secondary outcome of the ProCCM trial. We analysed five ANC outcomes: (1) number of ANC contacts, (2) at least one ANC contact, (3) at least four ANC contacts, (4) at least eight ANC contacts and (5) ANC initiated in the first trimester. We assumed two perspectives, a CHW programme's and the Full ANC programme's perspective, which included facility-based as well as community-based ANC. We estimated programme costs, incremental cost-effectiveness ratios (ICERs) and probabilities of the intervention being more cost-effective than the control at different willingness-to-pay (WTP) thresholds.

Results: Proactive home visits were cost-saving from the CHW programme's perspective (ICERs: -$21.39 to -$79.20 per ANC utilisation outcome) and from the Full ANC programme perspective (ICERs: -$1.70 to -$6.30 per ANC utilisation outcome) compared with the fixed-site CHW care. The likelihood of the intervention being more cost-effective than the control was 100% at WTP thresholds $0 per ANC utilisation outcome and between $12.5 and $50.00 per ANC utilisation outcome in the CHW- and Full ANC programme perspectives, respectively.

Conclusion: Our results provide evidence that proactive home visits produce more value per dollar spent as a means of improving the uptake of ANC services compared with fixed-site CHW services.

Trial registration number: NCT02694055.

Keywords: Global Health; Health economics; Health services research; Health systems; Maternal health.

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Conflict of interest statement

Competing interests: OO, MS and AZ report other grants from the Bill and Melinda Gates Foundation. OO also reports grants and consulting fees from the Partnership for Maternal Newborn and Child Health. OO is a board member of the Health Economics and Financing Programme at the Africa Centers for Disease Control. CW was employed by Muso at the time of the trial. AJ is the CEO of Muso Health and also serves as a voluntary member of the WHO’s external review group for the development of a curriculum guide for community health workers and as advisory board chair of the community health impact coalition.

Figures

Figure 1
Figure 1. The results of the bootstrap analysis for each of the five ANC outcomes from the CHW programme’s perspective. ANC, antenatal care; CHW, community health worker.
Figure 2
Figure 2. shows the results of the bootstrap analysis for each of the five ANC outcomes from the Full ANC programme’s perspective. ANC, antenatal care; CHW, community health worker
See this image and copyright information in PMC

References

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