Background
Methods
Study context
Analytical strategy
Data collection
Intervention | Control | |||
---|---|---|---|---|
Outcome | Number | Percent | Number | Percent |
Recovered | 581 | 94.17 | 187 | 88.21 |
Defaulted | 28 | 4.54 | 23 | 10.85 |
Dead | 5 | 0.81 | 2 | 0.94 |
Non-responder | 3 | 0.49 | 0 | 0.00 |
Total discharged | 617 | 100 | 212 | 100 |
Data analysis
Activity-based cost analysis
Activity | Description | Data sources |
---|---|---|
Support | Non-governmental organisation (NGO) finance, human resources and logistics services, NGO office and staff accommodation, transport (motorbikes, fuel and vehicle repairs), office materials, health centre rent and utilities, opportunity costs of community leaders time and rent for community-based health centre where CHW-delivered services in intervention arm. | Review of NGO accounting data, time allocation interviews with government and NGO field and management staff, government costs estimated through interviews with management staff. Community time and missed labour costs estimated through time allocation interviews with key informants from community and cross checked with NGO and government staff. |
Supervision and monitoring | Salaries: field supervisors and monitors, NGO management staff, government supervision staff, costs associated with CHW monthly meetings. | Review of NGO accounting data, ‘off budget’ costs for government staff estimated through interviews, time allocation interviews with government and NGO field and management staff. |
Training | Salaries: field staff, NGO management staff, CHWs in intervention and control arms. Direct training costs: location, trainers, transport and per diems. | Review of NGO accounting data, ‘off budget’ costs for government staff estimated through interviews, time allocation interviews with government and NGO field and management staff. |
Sensitisation and mobilisation | Salaries: field supervisors, monitors, CHWs for intervention and control arms. Direct mobilisation activity costs. | Review of NGO accounting data, ‘off budget’ costs estimated through interviews with government and NGO partners, time allocation interviews with field supervisors and monitors. |
Screening | Salaries: CHWs intervention and control and CHW volunteers | Review of NGO accounting data, ‘off budget’ costs estimated through interviews with government and NGO partners. Time allocation interviews with field and management staff. |
Counselling | Salaries: CHWs intervention and control and CHW volunteers. | Review of NGO accounting data, ‘off budget’ costs estimated through interviews with government and partners. Time allocation interviews with field and management staff. |
Treatment | RUTF (supply, transport and storage), salaries: CHWs intervention arm and health centre staff, NGO office and accommodation, implementation materials (scales, bowls and spoons, sugar for appetite test, hygiene products), storage. | Review of NGO accounting data, interviews with UNICEF, Save the Children, Action Against Hunger and government staff, time allocation interviews with Action Against Hunger and government staff. |
Household costs | Opportunity costs of accessing treatment and money spent accessing services | Focus group discussions with beneficiary households on time allocated to accessing treatment, financial costs and lost income. |
Cost-effectiveness analysis, base case
Sensitivity analyses
Outcome | Intervention | Control | ||
---|---|---|---|---|
Number | Percent | Number | Percent | |
Recovered | 581 | 83.12 | 187 | 79.57 |
Defaulted | 28 | 4.01 | 23 | 9.79 |
Dead | 5 | 0.72 | 2 | 0.85 |
Non-responder | 3 | 0.43 | 0 | 0.00 |
Transferred to inpatient/other outpatient facility | 81 | 11.59 | 22 | 9.36 |
Lost to follow-up | 1 | 0.14 | 1 | 0.43 |
Total | 699 | 100 | 235 | 100 |
Results
Costs
Intervention | Control | |||
---|---|---|---|---|
All costs | USD | % total costs | USD | % total costs |
Personnel
|
87 926
|
58.4
|
56 632
|
60.5
|
CHWs (salaries and incentives) | 10 332 | 6.9 | 3 982 | 4.3 |
Field supervision and medical staff | 28 193 | 18.7 | 17 194 | 18.4 |
Management and technical staff | 45 656 | 30.3 | 32 536 | 34.7 |
Support staff (logistics, finance, administrative) | 3 746 | 2.5 | 2 921 | 3.1 |
Programme costs
|
35 648
|
23.7
|
20 848
|
22.3
|
Office and programme materials | 1 756 | 1.2 | 1 324 | 1.4 |
RUTF (supply) | 17 795 | 11.8 | 5 648 | 6.0 |
Training costs (trainer, location, supplies) | 9 248 | 6.1 | 7 407 | 7.9 |
Supervision and monitoring | 6 849 | 4.6 | 6 469 | 6.9 |
Logistics
|
20 732
|
13.8
|
12 953
|
13.8
|
Rent and utilities | 8 927 | 5.9 | 2 767 | 3.0 |
Transport (car rental, maintenance and fuel) | 10 025 | 6.7 | 9 621 | 10.3 |
RUTF transport and storage | 1 780 | 1.2 | 565 | 0.6 |
Community contributions
|
6 218
|
4.1
|
3 208
|
3.4
|
Costs to households | 4 807 | 3.2 | 3 191 | 3.4 |
Opportunity costs for community leaders | 35 | 0.0 | 17 | 0.0 |
Community-level rent | 1 376 | 0.9 | 0 | 0.0 |
Total
|
150 523
|
100.0
|
93 641
|
100.0
|
Cost to government | 11 881 | 7.9 | 5 341 | 5.7 |
Cost to partners | 132 425 | 88.0 | 85 093 | 90.9 |
Cost to community | 6 218 | 4.1 | 3 208 | 3.4 |
Cost-effectiveness
Outcome | Intervention (observed, base case) | Control (observed, base case) | Intervention (modelled scenario) | Control (modelled scenario*) |
---|---|---|---|---|
Total cost (USD) | 150 523 | 93 641 | 146 744 | 116 251 |
# children in program | 617 | 212 | 617 | 617 |
Recovery rate | 94.17% | 88.21% | 94.17% | 88.21% |
Number of children recovered | 581 | 187 | 581 | 544a |
Cost per child treated | 244 | 442 | 238 | 188 |
Cost per child recovered | 259 | 501 | 253 | 214 |
Sensitivity analysis
Parameter | Base case | Worst case | Best case | Source |
---|---|---|---|---|
Recovery rate, intervention | 94.17% | 83.12% | 94.17% | Base—cohort study Worst—percentage including transfers and loss to follow-up Best—base case for intervention arm |
Recovery rate, control | 88.21% | 79.57% | 94.17% | |
Cost per child, intervention, base case | 244 | 260 | 228 | Base—average cost per child Worst/Best—calculated based on percentage range for each cost sub-category |
Cost per child, control, base case | 442 | 460 | 424 | |
Cost per child, intervention, modelled scenario | 238 | 269 | 166 | |
Cost per child, control, modelled scenario | 188 | 216 | 133 |
Univariate sensitivity analysis
Multivariate probabilistic sensitivity analysis
Modelled scenario sensitivity analysis
Discussion
Cost-effectiveness
Cost outcome | Mali | Bangladesh [18] | Ethiopia [4] | Malawi [5] | Zambia [6] | |||
---|---|---|---|---|---|---|---|---|
CHW/OTP | CHW | OTP | CHW | OTP | CHW | OTP | OTP | OTP |
Scenario/base case | Base case | Base case | Scenario | Scenario | ||||
Per recovered case (USD) | 259 | 501 | 253 | 214 | 180 | 145 | 185 | – |
Per treated case (USD) | 244 | 442 | 238 | 188 | 165 | 135 | 169 | 203 |