title: Economic evaluation of the practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi: study protocol for cost-effectiveness analysis.
abstract: BACKGROUND
  Chronic airway diseases pose a big challenge to health systems in most developing countries, particularly in Sub-Saharan Africa. A diagnosis for people with chronic or persistent cough is usually delayed because of individual and health system barriers. However, delayed diagnosis and treatment facilitates further transmission, severity of disease with complications and mortality. The objective of this study is to assess the cost-effectiveness of the practical approach to lung health strategy, a patient-centred approach for diagnosis and treatment of common respiratory illnesses in primary healthcare settings, as a means of strengthening health systems to improve the quality of management of respiratory diseases.
  
  
  METHODS
  Economic evaluation nested in a cluster randomised controlled trial with three arms will be performed. Measures of effectiveness and costs for all arms of the study will be obtained from the cluster randomised controlled clinical trial. The main outcome measures are a combined rate of major respiratory diseases milestones and process indicators extracted from the practical approach to lung health strategy. For analysis, descriptive as well as regression techniques will be used. A cost-effectiveness analysis will be performed according to intention-to-treat principle and from a societal perspective. Cost-effectiveness ratios will be calculated using bootstrapping techniques.
  
  
  CONCLUSIONS
  We hope to demonstrate the cost-effectiveness of the practical approach to lung health and informal healthcare providers, see an improvement in patients' quality of life, achieve a reduction in the duration and occurrence of episodes and the chronicity of respiratory diseases, and are able to report a decrease in the social cost. If the practical approach to lung health and informal healthcare provider's interventions are cost-effective, they could be scaled up to all primary healthcare centres.
  
  
  BACKGROUND
  PACTR: PACTR201411000910192.
authors.affiliation: Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK. elvis.gama@lstmed.ac.uk.
authors.forename: Elvis
authors.initials: E
authors.lastname: Gama
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK. j.j.madan@warwick.ac.uk.
authors.forename: Jason
authors.initials: J
authors.lastname: Madan
authors.affiliation: Reach Trust, ᅟ, Lilongwe, Malawi. hastings@reachtrust.org.
authors.forename: Hastings
authors.initials: H
authors.lastname: Banda
authors.affiliation: Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK. bertie.squire@lstmed.ac.uk.
authors.forename: Bertie
authors.initials: B
authors.lastname: Squire
authors.affiliation: Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK. r.thomson@lstmed.ac.uk.
authors.forename: Rachael
authors.initials: R
authors.lastname: Thomson
authors.affiliation: Reach Trust, ᅟ, Lilongwe, Malawi. ireen@reachtrust.org.
authors.forename: Ireen
authors.initials: I
authors.lastname: Namakhoma
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D001987:Bronchiectasis / Q000175:diagnosis; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003371:Cough / Q000175:diagnosis; D003906:Developing Countries; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D005791:Patient Care / Q000191:economics / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000191:economics; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics