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      Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso

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          Abstract

          Introduction

          Child health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale.

          Methods

          We collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012–2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention’s incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD.

          Results

          The provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI −38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018–2020, varied between $7 in Malawi to $27 in Burundi.

          Conclusion

          This study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale.

          Trial registration number

          NCT01517230; Results.

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          Most cited references20

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          Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6.

          A model's purpose is to inform medical decisions and health care resource allocation. Modelers employ quantitative methods to structure the clinical, epidemiological, and economic evidence base and gain qualitative insight to assist decision makers in making better decisions. From a policy perspective, the value of a model-based analysis lies not simply in its ability to generate a precise point estimate for a specific outcome but also in the systematic examination and responsible reporting of uncertainty surrounding this outcome and the ultimate decision being addressed. Different concepts relating to uncertainty in decision modeling are explored. Stochastic (first-order) uncertainty is distinguished from both parameter (second-order) uncertainty and from heterogeneity, with structural uncertainty relating to the model itself forming another level of uncertainty to consider. The article argues that the estimation of point estimates and uncertainty in parameters is part of a single process and explores the link between parameter uncertainty through to decision uncertainty and the relationship to value-of-information analysis. The article also makes extensive recommendations around the reporting of uncertainty, both in terms of deterministic sensitivity analysis techniques and probabilistic methods. Expected value of perfect information is argued to be the most appropriate presentational technique, alongside cost-effectiveness acceptability curves, for representing decision uncertainty from probabilistic analysis.
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            Cost effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules.

            Cost-effectiveness analysis (CEA) is increasingly important in public health decision making, including in low- and middle-income countries. The decision makers' valuation of a unit of health gain, or ceiling ratio (lambda), is important in CEA as the relative value against which acceptability is defined, although values are usually chosen arbitrarily in practice. Reference case estimates for lambda are useful to promote consistency, facilitate new developments in decision analysis, compare estimates against benefit-cost ratios from other economic sectors, and explicitly inform decisions about equity in global health budgets. The aim of this article is to discuss values for lambda used in practice, including derivation based on affordability expectations (such as $US150 per disability-adjusted life-year [DALY]), some multiple of gross national income or gross domestic product, and preference-elicitation methods, and explore the implications associated with each approach. The background to the debate is introduced, the theoretical bases of current values are reviewed, and examples are given of their application in practice. Advantages and disadvantages of each method for defining lambda are outlined, followed by an exploration of methodological and policy implications.
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              Spectrum: a model platform for linking maternal and child survival interventions with AIDS, family planning and demographic projections

              Background LiST is implemented in Spectrum, a modular computer program designed to examine the impact of interventions on health outcomes. A typical LiST application uses three other modules in Spectrum addressing demography, family planning and HIV/AIDS. Methods The demographic module projects the population by single age and sex over time and uses LiST calculations of the mortality rates by age group to calculate the number of deaths. The family planning module uses the proximate determinants of fertility framework to calculate the effects of increasing contraceptive use on the total fertility rate and, thus, the number of births. The HIV/AIDS module calculates the consequences of HIV epidemic trends on child mortality and the effects of programs to prevent mother-to-child transmission of HIV, cotrimoxazole prophylaxis and anti-retroviral treatment on the number of AIDS deaths. Results These modules provide LiST with estimates of the number of children and number of deaths by single age as they are affected by changes in fertility through family planning and interventions to prevent the transmission of HIV or delay AIDS death. Conclusions Integrating LiST within the existing Spectrum system of planning models expands the scope of LiST to include the effects of demographic change, family planning and HIV interventions.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2018
                16 July 2018
                : 3
                : 4
                : e000809
                Affiliations
                [1 ] departmentDepartment of Global Health and Development , London School of Hygiene and Tropical Medicine , London, UK
                [2 ] Development Media International CIC , London, UK
                [3 ] departmentCentre for Maternal Adolescent Reproductive and Child Health (MARCH) , London School of Hygiene and Tropical Medicine , London, UK
                [4 ] Centre MURAZ , Bobo-Dioulasso, Burkina Faso
                [5 ] Africsanté , Bobo-Dioulasso, Burkina Faso
                Author notes
                [Correspondence to ] Frida Kasteng; frida.kasteng@ 123456lshtm.ac.uk
                Author information
                http://orcid.org/0000-0002-1817-8371
                Article
                bmjgh-2018-000809
                10.1136/bmjgh-2018-000809
                6058168
                30057798
                b85ae62a-3db6-44c6-b6d6-a959fb0d91e4
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 03 March 2018
                : 17 May 2018
                : 18 May 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Funded by: Planet Wheeler Foundation;
                Categories
                Research
                1506
                Custom metadata
                unlocked

                health economics,health education and promotion,child health,cluster randomized trial

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