Cost-effectiveness analysis and mortality impact estimation of scaling-up pregnancy test kits in Madagascar, Ethiopia and Malawi

Bibliographic Data

ID11490457
AuthorsRobert John Kolesar (0000-0001-5535-3143, Centre National de la Recherche Scientifique, corresponding author), Martine Audibert (0000-0002-6187-2502, Centre National de la Recherche Scientifique), Alison B Comfort (0000-0001-6713-5258, University of California, San Francisco)
Year2017
Volume32
Issue6
Pages869-881
Publication date2017-07-01
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czx013
PMID28387867
OpenAlexW2604259762
LanguageEN
Citations received5
References cited20

Cost-effective, innovative approaches are needed to accelerate progress towards ending preventable infant, child and maternal mortality. To inform policy decisions, we conducted a cost-effectiveness analysis of adding urine pregnancy test kits to the maternal and reproductive services package offered at the community level in Madagascar, Ethiopia and Malawi. We used a decision tree model to compare the intervention with the status quo for each country. We also completed single factor sensitivity analyses and Monte Carlo simulations with 10 000 iterations to generate the probability distribution of the estimates and uncertainty limits. Among a hypothetical cohort of 100 000 women of reproductive age, we estimate that over a 1-year period, the intervention would save 26, 35 and 48 lives in Madagascar, Ethiopia, and Malawi, respectively. The Incremental Cost Effectiveness Ratio (ICER) for the cost per life saved varies by country: $2311 [95% Uncertainty Interval (UI): $1699; $3454] in Madagascar; $2969 [UI: $2260; $5041] in Ethiopia and $1228 [UI: $918; $1777] in Malawi. This equates to an average cost per Disability Adjusted Life Year (DALY) averted of $36.28, $47.95 and $21.92, respectively. Based on WHO criteria and a comparison with other maternal, newborn, and child health interventions, we conclude that the addition of urine pregnancy tests to an existing community health worker maternal and reproductive services package is highly cost-effective in all three countries. To optimize uptake of family planning and antenatal care services and, in turn, accelerate the reduction of mortality and DALYs, decision makers and program planners should consider adding urine pregnancy tests to the community-level package of services.

Cost effectiveness · Developing country · Disability-adjusted life year · Disease burden · Economic growth · Economics · Environmental health · Population · Pregnancy · Psychological intervention · Reproductive health · Risk analysis (engineering) · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing

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