Cost-Effectiveness Analysis Of Home Management Of Fevers In Children Under-Five Years In The Dangme West District Of Ghana

Abstract

Background Home management of childhood illnesses has been promoted as a way of managing childhood illnesses within communities. This approach can be life-saving, especially in rural areas of developing countries where geographical access to essential health services is limited. Many sub-Saharan African countries have adopted this approach and developed policies on its implementation. Ghana is implementing this policy, targeting malaria, pneumonia and diarrhea. However, there is little empirical evidence on the cost-effectiveness of these interventions. The objective of this study was, therefore, to assess the cost-effectiveness of two strategies of home management of fevers in children under-five in Ghana using antimalarials only or in combination with antibiotics. Methods Data were collected as part of a cluster randomised controlled trial with a stepwedged design. Approximately 12,000 children aged two months to 59 months in the Dangme West District in southern Ghana were covered. The costs and costeffectiveness of the two interventions were assessed compared with the "control period" before the clusters were randomized as part of the step-wedged design. In addition, a three-year budget of the home-based care (HBC) currently being implemented nationally in Ghana were estimated by adjusting parameters from the trial. Costs were analyzed from societal perspective. Under-five anaemia cases averted, deaths averted and disability-adjusted life years (DALYs) averted were used as effectiveness measures. Results The total financial costs of the interventions were US$99,690.32 (antimalarial only) and US$138,321.21 (antimalarial plus antibiotic). The total economic costs for the interventions were US$204,394.72 (antimalarial only) and US$260,93 1.49 (antimalarial plus antibiotic). Recurrent costs constituted 89% and 90% of the total direct costs of antimalarials only and antimalarial plus antibiotic respectively. The number of eligible fever cases treated were 5,818 (antimalarial only) and 6,601 (antimalarial plus antibiotic). The anaemia cases averted were 1,361 (antimalarial only) and 1,147 (antimalarial plus antibiotics) and the deaths averted were 79.1 and 79.9 for antimalarial only and antimalarial plus antibiotic respectively. The DALYs averted were 2,264.8 (antimalarial only) and 2,284.6 (antimalarial plus antibiotic). The results show that cost per anaemia case averted was US$150.18 and US$227.49 for antimalarial only and antimalarial plus antibiotic respectively. The cost per death averted was US$2,585.58 for antimalarial only and US$3,272.20 for antimalarial plus antibiotic. Cost per DALY averted were US$90.25 (antimalarial only) and US$114.21 (antimalarial plus antibiotic). Further, the home management interventions together led to societal savings of about US$165,083. The results also show that caregivers of children under-five incur intangible costs such as pain and loss of leisure that are difficult to quantify. Additionally, the budgets to cover 50% of the target population under HBC for 2012 were also estimated to be about US$1.6m illion for antimalarial only and about US$3.4million for antimalarial plus antibiotic. Conclusion Home management of fevers is a cost-effective way of reducing morbidity and mortality in children under five years in Ghana.