Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

Abstract

BackgroundDiarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the ‘no treatment’ approach (NT); the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI); and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI).MethodsMarkov cohort model conducted from the payer’s perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state). Disability adjusted life years (DALYs) averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER) served as measure of cost-effectiveness.ResultsBased on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita), all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation.ConclusionRotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria.

Cost-Effectiveness Analysis of Community Case Management of Childhood Diarrhea in Burundi

“…To reach our goal, a Markov model was built. As previously proven in a study conducted in Nigeria 14 and Tanzania, 15 our constructed model had the ability to mimic the natural history of the disease and capture all required effects of our intervention. For model input parameters, we strived to use certain country-specific estimates from either reliable evidence of the literature or our primary survey.…”

“…The program targets children under the age of 5 years because the risk of diarrhea is very high among children up to 5 years of age. 11 Therefore, a time horizon of 5 years was set for this analysis similarly to previous studies 14,15 because the effect of the treatment with CCM program does not last long.…”

“…A Markov model was constructed to mimic the natural history of the disease on the basis of previous studies. 14,15 Diarrheal diseases can reoccur several times, especially in children under the age of 5 years, who are most vulnerable to diarrhea. In our model, as illustrated in Figure 1, we assumed that every type of diarrhea will start in the mild state.…”

“…Therefore, the cycle length was set at 1 week, similar to previous studies. 14,15 From the DHS, the incidence rate was estimated to be 3.9 episodes per personyear. 10 Therefore, we allowed in our base case analysis a child to develop up to 3.9 episodes per year.…”