Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh

Abstract

Objective To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh. Methods In a cluster-randomized controlled trial, two strategies for neonatal care - known as home care and community care - were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy - compared with that of the pre-existing levels of maternal and neonatal care - was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis. Findings The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$2971 (95% CI: 1844-7628) and US$104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective - with 95% certainty - if healthy life years were valued above US$214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective. Conclusion The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.