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Table 1 Summary of studies included in the review

From: Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review

Study Intervention(s) Comparator Countries Disease area Quality Incremental intervention costs Effectiveness measure Incremental benefits ICER Multiples of GDP per capita per unit of effectivenessa
By whom care is provided
Long et al. (2011) [18] Nurse led care Doctor led care South Africa HIV 7 −59 (US$ 2009) In care and responding + 6 pp − 983* −0.09
Barton et al. (2013) [19] (i) Cohort 1 (ii) Cohort 2 Nurse led care Doctor led care South Africa HIV 9 (i) 103 (ii) 59 (US$ 2009) (i) Death rate (ii) Undetectable viral load (i) -0.4 pp. (ii) -0.5 pp. (i) 24,500 (ii) 12,584 (i) 2.26 (ii) 1.16
Marseille et al. (2014) [26] (i) Dedicated mobile male circumcision teams (ii) Non-dedicated, mobile integrated male circumcision Standard care Kenya HIV 5 (i) 29.32 (ii) 46.20 (US$ 2009) HIV cases averted NR (i) 117 (ii) 185 (i) 0.05 (ii) 0.08
Khan et al. (2002) [33] (i) DOTS observed by health workersb (ii) DOTS observed by family members (iii) DOTS delivered at health centre DOTS without direct observation Pakistan TB 6 (i) 12 (ii) 0 (iii) 72 (US$ 1998) Cure rate (i) + 5 pp. (ii) -7 pp. (iii) -4 pp (i) 260*b (ii) 0* (iii) -1800* (i) 0.11b (ii) 0 (iii) -0.73
Islam et al. (2002) [28] CHW provided community care Health facility doctor-led care Bangladesh TB 5 −31.8 (US$ 1997) Cure rate + 2 pp − 1590* −1.39
do Prado et al. (2011) [39] Guardian supervised DOTS CHW supervised DOTS Brazil TB 6 − 158 (US$ NR) Cure rate + 14 pp − 1095* −0.08
Prinja et al. (2014) [40] Two auxiliary nurse midwives Single auxiliary nurse midwife India Obstetric care 7 −18 (INR 2012) ANC coverage + 18 pp 23,058 0.07
Gaziano et al. (2014) [29] Providing CVD training to CHWs Standard care South Africa CVD 8 6.56 (US$ 2012) DALYs 0.0205 320 0.04
Saokaew et al. (2013) [30] Pharmacist participated warfarin management Standard care Thailand Patients receiving warfarin 7 3083 (US$ NR) DALYs 0.79 3882 0.71
Buttorff et al. (2012) [31] Lay health worker task sharing Doctor/specialist led care India Mental health 8 −46 (US$ 2009) QALYs 0.02 − 2300* −0.38
Jayaraman et al. (2009) [32] Trauma care program for lay first-responders No program Uganda Emergency care 5 0.36 (US$ NR) Death rate NR 598 0.50
To whom care is provided
Brooker et al. (2008) [52] School-based helminth control program No program Uganda Helminthiasis 10 0.54 (US$ 2005) Anaemia risk −16.7 pp 3.19 0.00
Lo et al. (2015) [53] Community-wide mass drug administration School-based helminth control program Côte d’Ivoire Helminthiasis 7 240,695 (US$ 2014) [Total] DALYs 1443 167 0.11
Where care is provided
Babigumira et al. (2009) [20] (i) Mobile clinic delivered care (ii) Home based care Facility based care Uganda HIV 6 (i) 1569 (ii) 2251 (US$ 2008) QALY (i) + 0.6 (ii) + 0.8 (i) 2615 (ii) 2814 (i) 2.27 (ii) 2.45
Babigumira et al. (2011) [21] Pharmacy only refill program Standard care Uganda HIV 8 − 135 (US$ NR) Favourable immune response -1 pp 13,500 10.31
Mulogo et al. (2013) [22] Home based testing Facility based testing Uganda HIV 3 −1.4 (US$ 2008) Cases identified + 2 pp −3.5 −0.00
Bassett et al. (2014) [23] Mobile testing Facility based testing South Africa HIV 5 100 (US$ 2012) Life expectancy + 0.5 months 2400 0.33
Smith et al. (2015) [24] Community based management: (i) ART threshold ≤200 CD4 per μL (ii) No ART threshold Facility based management South Africa HIV 7 (i) 157 (ii) 293 (US$ NR) DALYs (i) 0.20 (ii) 0.33 (i) 22,000 (ii) 8570 (i) 3.32 (ii) 1.30
Tabana et al. (2015) [25] Home based counselling and testing Facility based counselling and testing South Africa HIV 7 4.4 (US$ 2012) Uptake of testing + 21 pp 19 0.00
Chanda et al. (2011) [34] Home management Facility based management Zambia Malaria 8 2.38 (US$ 2010) Appropriately treated + 57 pp 4.2 0.00
Kahn et al. (2012) [35] Integrated community prevention program Standard care Kenya HIV, Malaria, Diarrhoea 4 32 (US$ NR) DALYs Costs saved 0.359 NR NR NR
Marseille et al. (2014) [41] Integrated community prevention program Standard care 70 countries HIV, Malaria, Diarrhoea 5 26–147 (US$ NR) DALYs 0.00–1.14 7–15,886
Jafar et al. (2011) [36] (i) Home health education with trained GP (ii) Home health education only (iii) Trained GP only Standard care Pakistan Blood pressure 6 (i) 3.99 (ii) 3.34 (iii) 0.65 (US$ 2007) DALYs NR (i) 23 (ii) 730 (iii) 807 (i) 0.02 (ii) 0.78 (iii) 0.87
Chen et al. (2012) [37] Volunteer orthopaedic surgery trips Standard care Nicaragua Orthopaedic surgery 7 711 (US$ 2010) DALYs + 1.49 352 0.23
Pitt et al. (2016) [38] Newborn home visits Standard care Ghana Obstetric care 6 0.53 (US$ 2009) Life years saved NR 352 0.32
Quality and safety
Goodman et al. (2006) [42] Drug safety training for shopkeepers No training Kenya Malaria 8 0.43 (US$ 2000) (i) Appropriate treatment for malaria (ii) DALYs (i) 13 pp. (ii) 894 [Total] (i) 4 (ii) 18.38 (i) 0.00 (ii) 0.01
Vella et al. (2011) [27] Full time staff and high staff patient ratio clinic Part time staff and low staff to patient ratio clinic South Africa HIV 5 8410 (US$ 2006) Patients retained + 30 pp 12,271 1.23
Barasa et al. (2012) [43] Quality improvement for children in hospitals Standard care Kenya All 8 19.68 (US$ 2009) DALYs NR 39.8–398.3 c 0.02–0.17 c
Curry et al. (2013) [44] Quality improvement for rural primary care (i) 18 month intervention period (ii) Five year follow-up Standard care Ethiopia All 5 (i) 5 million (ii) 5 million (US$ NR) [Total costs] Lives saved (i) 134 (ii) 968 [Total] (i) 37,313 (ii) 5071 (i) 74.60 (ii) 10.14
Broughton et al. (2011) [45] Quality improvement in children’s hospital Standard care Nicaragua Pneumonia 5 −14 (US$ 2010) DALYs 0.06 − 233 −0.15
Clark et al. (2012) [46] Quality improvement Standard care Sierra Leone Emergency care 5 29,714 (US$ 2009) Mortality risk −6.5 pp 148 0.34
Alfonso et al. (2015) [47] Quality improvement with voucher scheme Standard care Uganda Obstetric care 8 0.41 (US$ 2010) (i) DALYs (ii) Mortality risk (i) 0.0014 (ii) -0.002 pp (i) 302 (ii) 20,475 (i) 0.24 (ii) 16.51
Manasyan et al. (2011) [48] Newborn care training in urban facilities Standard care Zambia Obstetric care 6 20,223 (US$ 2005) DALYs NR 5.24 0.00
Prinja et al. (2016) [49] Integrated newborn and child health program Standard care India Child health 8 4.7 (US$ NR) DALYs NR 34.5 0.01
Information and communication technology
Li et al. (2012) [50] Electronic medical records Standard care China All 4 NR Net benefits ($) [Hospital level, 6 year horizon] NR 559,025 NR
Anchala et al. (2015) [51] Decision support system Standard care India Blood pressure 9 25.79 (US$ NR) mm Hg −6.59 3.91 0.00
  1. ANC = antenatal care; DALY = disability adjusted life year; DOTS = directly observed treatment; ICER = incremental cost-effectiveness ratio; NR = not reported;
  2. pp = percentage point; QALY = quality adjusted life year
  3. Bold indicates an intervention that dominates (i.e. less costly and more effective) the alternative(s)
  4. Underlined indicates that an intervention would be considered highly cost-effective by WHO standards (< 1× GPD per capita per DALY averted)
  5. Shading separates disease groups
  6. Incremental costs and effects are per person unless otherwise stated
  7. ICERs are in terms of the effectiveness unit given, e.g. cost per case cured
  8. DALYs are reported as DALYs averted
  9. aThe ICER divided by GDP per capita in purchasing power parity terms for the study year
  10. bThe intervention was dominant over an alternative
  11. cMultiple effectiveness scenarios considered
  12. *ICERs were calculated from average figures given in the article and was not reported itself in the article