Incremental cost and cost-effectiveness of low-dose, high-frequency training in basic emergency obstetric and newborn care as compared to status quo: part of a cluster-randomized training intervention evaluation in Ghana

Abstract

BackgroundLow-dose, high-frequency (LDHF) training is a new approach best practices to improve clinical knowledge, build and retain competency, and transfer skills into practice after training. LDHF training in Ghana is an opportunity to build health workforce capacity in critical areas of maternal and newborn health and translate improved capacity into better health outcomes.MethodsThis study examined the costs of an LDHF training approach for basic emergency obstetric and newborn care and calculates the incremental cost-effectiveness of the LDHF training program for health outcomes of newborn survival, compared to the status quo alternative of no training. The costs of LDHF were compared to costs of traditional workshop-based training per provider trained. Retrospective program cost analysis with activity-based costing was used to measure all resources of the LDHF training program over a 3-year analytic time horizon. Economic costs were estimated from financial records, informant interviews, and regional market prices. Health effects from the program’s impact evaluation were used to model lives saved and disability-adjusted life years (DALYs) averted. Uncertainty analysis included one-way and probabilistic sensitivity analysis to explore incremental cost-effectiveness results when fluctuating key parameters.ResultsFor the 40 health facilities included in the evaluation, the total LDHF training cost was $823,134. During the follow-up period after the first LDHF training—1 year at each participating facility—approximately 544 lives were saved. With deterministic calculation, these findings translate to $1497.77 per life saved or $53.07 per DALY averted. Probabilistic sensitivity analysis, with mean incremental cost-effectiveness ratio of $54.79 per DALY averted ($24.42–$107.01), suggests the LDHF training program as compared to no training has 100% probability of being cost-effective above a willingness to pay threshold of $1480, Ghana’s gross national income per capita in 2015.ConclusionThis study provides insight into the investment of LDHF training and value for money of this approach to training in-service providers on basic emergency obstetric and newborn care. The LDHF training approach should be considered for expansion in Ghana and integrated into existing in-service training programs and health system organizational structures for lower cost and more efficiency at scale.

A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare

“…17 As illustrated in Figure 1, a total of seven distinct articles were identified from both queries which reported cost analyses of large-scale training program implementations. 18,13,[19][20][21][22][23] See Table 3 for a detailed summary. Of these articles, one involved a US institution, and each of the six other articles involved low-or middle-income countries.…”

“…Several categories or types of cost were described and estimated in these studies. Willcox et al, 22 for example, assessed cost and cost-effectiveness of low-dose, high-frequency training in basic emergency obstetric and newborn care in Ghana as compared to standard-of-care approaches in a non-randomized study. They categorized and assessed development costs, start-up costs, and implementation costs.…”

Scale-Up of Doppler to Improve Intrapartum Fetal Heart Rate Monitoring in Tanzania: A Qualitative Assessment of National and Regional/District Level Implementation Factors

“…This was noted in HBB scale-up as well, as 87% of health care providers passed a competency exam immediately following training, but only 56% passed 4-6 months following training. In Tanzania, this drop-off in skills caused a programmatic shift to how health care providers were trained and supported following training [43]. The original 1-day HBB training was expanded by a half-day following development and implementation of a structured on-the-job training guide to standardize LDHF practice, review of service delivery data, and mentorship on clinical practice and data recording [23].…”

“…Policy and clinical guidance for improved intrapartum care is not the only important element of scale-up: as several respondents noted, government and donor funding must also support scale-up of Doppler. Although newborn deaths account for 39% of deaths of children under age 5 years in Tanzania [43], only a tiny proportion of funding is allocated to address this issue. In 2010, for example, $1.5 million was allocated to programs benefiting neonates, whereas in the same year, $208 million was allocated to reproductive health (family planning and sexually transmitted infections, including HIV) [18].…”

Pilot Study of a Breastfeeding Support Training Program Designed Particularly for Infants with Common Congenital Anomalies and Defects

“…The experimental groups were 2.9 times more likely to perform excellent CPR than the control group with a p value of 0.005. LDHF training appears to be an effective way to retain CPR skills Willcox et al (2017). applied LDHF training with a role play-based curriculum to neonatal outcomes in Ghana.…”