title: Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.
abstract: OBJECTIVE
  The Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania.
  
  
  METHODS
  Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health.
  
  
  RESULTS
  Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated.
  
  
  CONCLUSIONS
  The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.
authors.affiliation: SAFER (Stavanger Acute Medicine Foundation for Education and Research), Stavanger University Hospital, Stavanger, Norway.
authors.forename: Corinna
authors.initials: C
authors.lastname: Vossius
authors.affiliation: Research Institute, Haydom Lutheran Hospital, Haydom, Tanzania.
authors.forename: Editha
authors.initials: E
authors.lastname: Lotto
authors.affiliation: Research Institute, Haydom Lutheran Hospital, Haydom, Tanzania.
authors.forename: Sara
authors.initials: S
authors.lastname: Lyanga
authors.affiliation: Research Institute, Haydom Lutheran Hospital, Haydom, Tanzania.
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Georgina
authors.initials: G
authors.lastname: Msemo
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
authors.affiliation: SAFER (Stavanger Acute Medicine Foundation for Education and Research), Stavanger University Hospital, Stavanger, Norway; Research Institute, Haydom Lutheran Hospital, Haydom, Tanzania.
authors.forename: Hege L
authors.initials: HL
authors.lastname: Ersdal
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics*; D003479:Curriculum; D003906:Developing Countries; D055317:Evidence-Based Practice / Q000191:economics / Q000193:education*; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008505:Medical Staff, Hospital / Q000191:economics / Q000193:education*; D066189:Missionaries; D019057:Quality-Adjusted Life Years; D012151:Resuscitation / Q000191:economics / Q000193:education*; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania