Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting
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2015
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ndltd-OhioLink-oai-etd.ohiolink.edu-ucin14280647552021-08-03T06:29:47Z Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting Waruingi, Alice Anne Wambui Epidemiology prenatal care preterm birth cost-effectiveness resource-limited care Disability Adjusted Life Years Background: While the rate of preterm birth cannot accurately be known in some areas of the world, it is estimated that over 12% of infants in sub-Saharan Africa are born prematurely. In East Africa, small for gestational age (SGA) infants born at less than 37 weeks of completed gestation are far more likely to die than their term counterparts. Overall, many causes of preterm labor are preventable. Rigorous screening and treatment programs in pregnancy may significantly reduce the rate of preterm births related to treatable conditions.In Kenya, East Africa, 76-92% of women will have some access to prenatal care. Less than two-thirds report greater than 4 visits in total, with the average initiation of prenatal care being the sixth to seventh month. The World Health Organization (WHO) recommends a structured prenatal protocol within the framework of four prenatal visits in government-run clinics and impoverished regions. There is paucity of data relating to the cost-effectiveness of an aggressive screening and treatment package occurring within the framework of these four visits. The aim of this study is to determine if a more intensive prenatal screening and treatment package is cost-effective in reducing the rate of prematurity when the cost of preterm-birth related mortality and morbidity are factored in.Methodology: A cost-effectiveness analysis was done comparing two prenatal strategies; standard care versus an enhanced care strategy involving more intensive screening and treatment for anemia, syphilis, HIV, bacteriuria, gestational diabetes, and gestational hypertension. The time horizon of the analysis was through the end of a single pregnancy cycle. Costs were measured in US dollars pooled from various data sources. The endpoints were Disability Adjusted Life Years, associated with term delivery, pre-term delivery, or neonatal death related to preterm delivery. The outcome of interest was the marginal Cost-Effectiveness Ratio (mCER)of the enhanced strategy when compared to the standard screening strategy.Results: The enhanced screening strategy cost $7 more than the standard screening strategy, but resulted in a reduction of 0.45 DALYs at a cost of $15.50 per DALY averted compared to the current standard screening strategy. There was a mild increase in cost per DALYs averted in both strategies when care was started early, at 8-12 weeks (range US$10.8-16.52 per DALY averted). There was a reduction in cost per DALYs averted as the possibility of preterm birth increased in the standard care strategy, whereas costs increased per DALY averted as preterm births increased in the enhanced strategy . Enhanced screening cost less per DALY averted as the probability of term birth among women receiving enhanced care increased.Conclusion: Preterm birth etiology remains multifactorial; however incorporating rigorous, targeted strategies is cost- effective in improving neonatal outcomes. The next step would be to conduct a feasibility study in which the applicability of this model could be tested before any widespread changes in practice can be advocated. 2015-09-04 English text University of Cincinnati / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428064755 http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428064755 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |
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NDLTD |
| language |
English |
| sources |
NDLTD |
| topic |
Epidemiology prenatal care preterm birth cost-effectiveness resource-limited care Disability Adjusted Life Years |
| spellingShingle |
Epidemiology prenatal care preterm birth cost-effectiveness resource-limited care Disability Adjusted Life Years Waruingi, Alice Anne Wambui Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| author |
Waruingi, Alice Anne Wambui |
| author_facet |
Waruingi, Alice Anne Wambui |
| author_sort |
Waruingi, Alice Anne Wambui |
| title |
Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| title_short |
Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| title_full |
Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| title_fullStr |
Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| title_full_unstemmed |
Creating a Cost Effectiveness Model for the Prevention of Prematurity in a Low-Income, Resource-Poor Setting |
| title_sort |
creating a cost effectiveness model for the prevention of prematurity in a low-income, resource-poor setting |
| publisher |
University of Cincinnati / OhioLINK |
| publishDate |
2015 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428064755 |
| work_keys_str_mv |
AT waruingialiceannewambui creatingacosteffectivenessmodelforthepreventionofprematurityinalowincomeresourcepoorsetting |
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1719437959149649920 |