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

Watson, Samuel I.; Sahota, Harvir; Taylor, Celia A.; Chen, Yen-Fu; Lilford, Richard J.

doi:10.1186/s41256-018-0073-z

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 effectiveness^a
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 workers^b (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) 0.11^b (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

ANC = antenatal care; DALY = disability adjusted life year; DOTS = directly observed treatment; ICER = incremental cost-effectiveness ratio; NR = not reported;
pp = percentage point; QALY = quality adjusted life year
Bold indicates an intervention that dominates (i.e. less costly and more effective) the alternative(s)
Underlined indicates that an intervention would be considered highly cost-effective by WHO standards (< 1× GPD per capita per DALY averted)
Shading separates disease groups
Incremental costs and effects are per person unless otherwise stated
ICERs are in terms of the effectiveness unit given, e.g. cost per case cured
DALYs are reported as DALYs averted
^aThe ICER divided by GDP per capita in purchasing power parity terms for the study year
^bThe intervention was dominant over an alternative
^cMultiple effectiveness scenarios considered
*ICERs were calculated from average figures given in the article and was not reported itself in the article

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ISSN: 2397-0642

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