Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso

Kasteng, Frida; Murray, Joanna; Sarrassat, Sophie; Steel, Jennifer L.; Méda, Nicolas; Ouédraogo, Moctar; Head, Roy; Borghi, Josephine

doi:10.1136/bmjgh-2018-000809

Cited by 23 publications

(20 citation statements)

References 28 publications

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“…In addition, the predicted health benefits are comparable with current estimates of other interventions, such as the DALYS averted by the use of HIV protease inhibitors to prevent recurrent malaria incidence in HIV infected children [5,6] and prevention campaigns [54]. With respect to intervention costs, although higher costs per person unsurprisingly reduced the number of countries where a severe malaria intervention is cost-effective, our estimates of the ICER are comparable to various scale-up programs [55], and the effects of media on promoting life-saving practices [56].…”

Section: Discussionsupporting

confidence: 63%

Advocating an attack against severe malaria: a cost-effectiveness analysis

Greenhalgh

Chandwani

2020

BMC Public Health

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Background: A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. Methods: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. Results: Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2-to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very costeffective in 25 countries. Conclusion: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

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Section: Discussionsupporting

confidence: 63%

Advocating an attack against severe malaria: a cost-effectiveness analysis

Greenhalgh

Chandwani

2020

BMC Public Health

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“…In addition, the predicted health benefits are comparable with current estimates of other interventions, such as the DALYS averted by the use of HIV protease inhibitors to prevent recurrent malaria incidence in HIV infected children [5,6] and prevention campaigns [42]. With respect to intervention costs, although higher costs per person unsurprisingly reduced the number of countries where a severe malaria intervention is cost-effective, our estimates of the ICER are comparable to various scale-up programs [43], and the effects of media on promoting life-saving practices [44].…”

Section: Discussionsupporting

confidence: 63%

Advocating an attack against severe malaria: a cost-effectiveness analysis

Greenhalgh

Chandwani

2019

Preprint

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Background Recently a study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective.Methods Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings.Results Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries.Conclusion Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.

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“…The impact of changes in intervention coverage on under-five and maternal mortality were modelled, and these national projections were then adjusted to reflect the population reached in the CRT, estimated using government population data to be 2.4 million (around 15% of the total population of Burkina Faso). 20 We made a further adjustment to reflect radio penetration at national scale. To do this, we assumed that the number of people impacted would be directly proportional to the number of people exposed.…”

Section: Methodsmentioning

confidence: 99%

Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool (LiST): findings from a cluster randomised trial in Burkina Faso

Murray¹,

Head²,

Sarrassat

et al. 2018

BMJ Glob Health

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BackgroundA cluster randomised trial (CRT) in Burkina Faso was the first to demonstrate that a radio campaign increased health-seeking behaviours, specifically antenatal care attendance, health facility deliveries and primary care consultations for children under 5 years.MethodsUnder-five consultation data by diagnosis was obtained from primary health facilities in trial clusters, from January 2011 to December 2014. Interrupted time-series analyses were conducted to assess the intervention effect by time period on under-five consultations for separate diagnosis categories that were targeted by the media campaign. The Lives Saved Tool was used to estimate the number of under-five lives saved and the per cent reduction in child mortality that might have resulted from increased health service utilisation. Scenarios were generated to estimate the effect of the intervention in the CRT study areas, as well as a national scale-up in Burkina Faso and future scale-up scenarios for national media campaigns in five African countries from 2018 to 2020.ResultsConsultations for malaria symptoms increased by 56% in the first year (95% CI 30% to 88%; p<0.001) of the campaign, 37% in the second year (95% CI 12% to 69%; p=0.003) and 35% in the third year (95% CI 9% to 67%; p=0.006) relative to the increase in the control arm. Consultations for lower respiratory infections increased by 39% in the first year of the campaign (95% CI 22% to 58%; p<0.001), 25% in the second (95% CI 5% to 49%; p=0.010) and 11% in the third year (95% CI −20% to 54%; p=0.525). Diarrhoea consultations increased by 73% in the first year (95% CI 42% to 110%; p<0.001), 60% in the second (95% CI 12% to 129%; p=0.010) and 107% in the third year (95% CI 43% to 200%; p<0.001). Consultations for other diagnoses that were not targeted by the radio campaign did not differ between intervention and control arms. The estimated reduction in under-five mortality attributable to the radio intervention was 9.7% in the first year (uncertainty range: 5.1%–15.1%), 5.7% in the second year and 5.5% in the third year. The estimated number of under-five lives saved in the intervention zones during the trial was 2967 (range: 1110–5741). If scaled up nationally, the estimated reduction in under-five mortality would have been similar (9.2% in year 1, 5.6% in year 2 and 5.5% in year 3), equating to 14 888 under-five lives saved (range: 4832–30 432). The estimated number of lives that could be saved by implementing national media campaigns in other low-income settings ranged from 7205 in Burundi to 21 443 in Mozambique.ConclusionEvidence from a CRT shows that a child health radio campaign increased under-five consultations at primary health centres for malaria, pneumonia and diarrhoea (the leading causes of postneonatal child mortality in Burkina Faso) and resulted in an estimated 7.1% average reduction in under-five mortality per year. These findings suggest important reductions in under-five mortality can be achieved by mass media alone, particularly when conducted at national scale.

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Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso

Cited by 23 publications

References 28 publications

Advocating an attack against severe malaria: a cost-effectiveness analysis

Advocating an attack against severe malaria: a cost-effectiveness analysis

Advocating an attack against severe malaria: a cost-effectiveness analysis

Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool (LiST): findings from a cluster randomised trial in Burkina Faso

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