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Economic analysis of the CLIP Trials in India, Pakistan and Mozambique

Article scientifique 2020 Anglais

Résumé

Abstract Background: The Community-Level Interventions for Pre-eclampsia (CLIP) Trials (NCT01911494) in India, Pakistan, and Mozambique (February 2014-7) involved community engagement and task-sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the costs and cost-effectiveness of the CLIP intervention overall, and by POM visit frequency. Methods: Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1-3, 4-7, ³8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision-tree model was built to determine the cost-effectiveness of the intervention (vs. usual care), based on the primary clinical endpoint of years-of-life-lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes.Results: The incremental per pregnancy cost of the intervention was USD$12.66 (India), USD$11.51 (Pakistan) and USD$13.26 (Mozambique). As implemented, the intervention was not cost-effective, due largely to minimal differences in years-of-life-lost between arms. However, among women who received ≥8 contacts (4 in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries). Conclusion: The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting World Health Organization guidance on antenatal contact frequency.Funding: The University of British Columbia, a grantee of the Bill & Melinda Gates Foundation (OPP1017337).Trial registration: clinicaltrials.gov. Registered 30 July 2013, https://clinicaltrials.gov/ct2/show/NCT01911494

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Bone, J., Khowaja, A., Vidler, M., Payne, B., Bellad, M., Goudar, S., Mallapur, A., Munguambe, K., Qureshi, R., Sacoor, C., Sevene, E., Frederix, G., Bhutta, Z., Mitton, C., Magee, L., Dadelszen, P. (2020). Economic analysis of the CLIP Trials in India, Pakistan and Mozambique. https://doi.org/10.21203/rs.3.rs-60194/v2

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Auteur(s)

Jeffrey N. Bone Asif Raza Khowaja Marianne Vidler Beth A. Payne Mrutyunjaya B. Bellad Shivaprasad S. Goudar Ashalata Mallapur Khátia Munguambe Rahat Qureshi Charfudin Sacoor Esperança Sevene Geert Frederix Zulfiqar A Bhutta Craig Mitton Laura A. Magee Peter von Dadelszen

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