title: Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh.
abstract: OBJECTIVE
  To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh.
  
  
  METHODS
  In a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy--compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis.
  
  
  RESULTS
  The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$ 103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$ 104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective.
  
  
  CONCLUSIONS
  The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Suite E-8139, 615 North Wolfe Street, Baltimore MD 21205, United States of America (USA).
authors.forename: Amnesty E
authors.initials: AE
authors.lastname: LeFevre
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Shillcutt
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Waters
authors.forename: Sabbir
authors.initials: S
authors.lastname: Haider
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Mannan
authors.forename: Habibur R
authors.initials: HR
authors.lastname: Seraji
authors.forename: Rasheduzzaman
authors.initials: R
authors.lastname: Shah
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Steve N
authors.initials: SN
authors.lastname: Wall
authors.forename: Emma K
authors.initials: EK
authors.lastname: Williams
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D001459:Bangladesh; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D019538:Health Care Surveys; D006699:Home Care Services; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D017283:Neonatal Nursing / Q000191:economics*