title: Cost-effectiveness of an injury and drowning prevention program in Bangladesh.
abstract: OBJECTIVE
  Interventions that mitigate drowning risk in developing countries are needed. This study presents the cost-effectiveness of a low-cost, scalable injury and drowning prevention program called Prevention of Child Injuries through Social-Intervention and Education (PRECISE) in Bangladesh.
  
  
  METHODS
  Between 2006 and 2010, the 2 components of PRECISE (Anchal, which sequestered children in crèches [n = 18 596 participants], and SwimSafe, which taught children how to swim [n = 79421 participants]) were implemented in rural Bangladesh. Mortality rates for participants were compared against a matched sample of nonparticipants in a retrospective cohort analysis. Effectiveness was calculated via Cox proportional hazard analysis. Cost-effectiveness was estimated according to World Health Organization-CHOosing Interventions that are Cost Effective guidelines.
  
  
  RESULTS
  Anchal costs between $50.74 and $60.50 per child per year. SwimSafe costs $13.46 per child. For Anchal participants, the relative risk of a drowning death was 0.181 (P = .004). The relative risk of all-cause mortality was 0.56 (P = .001). For SwimSafe, the relative risk of a drowning death was 0.072 (P < .0001). The relative risk of all-cause mortality was 0.750 (P = .024). For Anchal, the cost per disability-adjusted life-year (DALY) averted is $812 (95% confidence interval: $589\x{2013}$1777). For SwimSafe, the cost per DALY averted is $85 ($51\x{2013}$561). Combined, the cost per DALY averted is $362 ($232\x{2013}$1364).
  
  
  CONCLUSIONS
  Based on World Health Organization criteria, PRECISE is very cost-effective and should be considered for implementation in other areas where drowning is a significant problem.
authors.affiliation: Centre for Injury Prevention and Research, New DOHS Mohakhali, Bangladesh.
authors.forename: Fazlur
authors.initials: F
authors.lastname: Rahman
authors.forename: Saideep
authors.initials: S
authors.lastname: Bose
authors.forename: Michael
authors.initials: M
authors.lastname: Linnan
authors.forename: Aminur
authors.initials: A
authors.lastname: Rahman
authors.forename: Saidur
authors.initials: S
authors.lastname: Mashreky
authors.forename: Benjamin
authors.initials: B
authors.lastname: Haaland
authors.forename: Eric
authors.initials: E
authors.lastname: Finkelstein
mesh_terms: D000056:Accident Prevention / Q000191:economics*; D001459:Bangladesh; D002423:Cause of Death; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D003906:Developing Countries; D004332:Drowning / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012306:Risk; D012424:Rural Population; D013550:Swimming / Q000193:education / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality / Q000517:prevention & control*