Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia

Abstract

BackgroundGhana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions.MethodsA cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey.ResultsAppropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region.ConclusionsIntegrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1906-9) contains supplementary material, which is available to authorized users.

Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies

“…Particularly, we found two studies assessing the cost of measles in the Federated States of Micronesia [49] and the cost of measles and rubella in Romania [50] -a first for measles and rubella in LMIC. Other studies examined further the cost of GE [51][52][53][54][55][56][57][58][59], pneumonia [51,52,[59][60][61][62][63], and influenza [64,65]. Some of them generated COI estimates from a programmatic approach, evaluating the cost of treating diarrhea and pneumonia through an integrated community case management [51,52,59].…”

“…Other studies examined further the cost of GE [51][52][53][54][55][56][57][58][59], pneumonia [51,52,[59][60][61][62][63], and influenza [64,65]. Some of them generated COI estimates from a programmatic approach, evaluating the cost of treating diarrhea and pneumonia through an integrated community case management [51,52,59]. Such an approach generates questions on the representativeness of the COI estimates, particularly for regions where integrated community case management is not implemented, where alternative care processes are in place, or where it faces logistical shortcomings, such as medication stock-outs, that affect the COI and how people decide to procure healthcare [66].…”

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

“…Moreover, many factors that impact the result of a cost-effectiveness analysis (CEA), such as incidence rate, the distribution of Plasmodium species, labor cost, and health workers’ awareness of malaria, were very different in different areas [ 11 , 12 ]. And previous cost-effectiveness researches barely paied the attention to evaluating the cost of FP case [ 13 – 16 ].…”

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

“…Moreover, many factors that impact the result of a cost-effectiveness analysis (CEA), such as incidence rate, the distribution of Plasmodium species, labor cost, and health workers' awareness of malaria, were very different in different areas [10,11]. And previous cost-effectiveness researches barely paied the attention to evaluating the cost of FP case [12][13][14][15].…”