Improving the Quality of Care of Sick Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis

Barasa W. E, Ayieko P, Cleary S, English M

Background

• Under 5 mortality continues to be a challenge globally

• In Kenya the under 5 mortality rate needs to reduce by 50% to meet the MDG 4 target

• The district hospital is an important avenue for delivering cost-effective child health interventions

• The quality of care in these hospitals has however been found to be poor in Kenya

• A multifaceted intervention to improve inpatient care in these hospital was tested and found to be effective.

• We present here a cost effectiveness analysis of the intervention

The Intervention

Objectives and Methods

Objectives

• To determine the total economic

costs of delivering ETAT+

• To assess the cost effectiveness

of the intervention

• To model the costs of scale up of

ETAT+ to a national level

Methods• A cost-effectiveness analysis

(CEA) alongside a cRCT

• Provider perspective

• Horizon – 18 months (Sep 2006 – Apr 2008)

• One way sensitivity analysis conducted on development & hotel costs, effectiveness and salaries

MethodsSample sizes• Process of care: 1158 & 1157 at

18 months in intervention and control hospitals respectively

• Resource use: 6199 & 5115 in

intervention and control hospitals

respectively

Measuring costs•An ingredients approach•Costs of developing, implementing and treatment where evaluated

Measuring effectiveness•Quality of care measured using process of care that span assessment, diagnosis and treatment

Assessing Costs-Effectiveness• Intervention study not designed

to measure mortality as a primary outcome

• The ICER was defined as the incremental cost per % improvement in QoC

• We also assessed likely cost per DALY averted estimates assuming plausible relative reductions in baseline inpatient mortality rate (7%) of between 1% and 10%

• This corresponds to absolute reductions in mortality of between 0.07% and 0.7%

Results: Intervention Costs Summary

Results: Incremental Cost-Effectiveness Ratio

•The additional cost per 1 percentage improvement in quality of care (ICER) was US$ 0.78 per child admission

Results: Estimated Costs of Scale-up

•Total costs of scale-up are US$ 3,633,123.45

Results: “What-If” Analysis

ICERs of other Key Child health Interventions

Discussions: Should ETAT+ be scaled up?

• There is therefore a strong case to scale up ETAT+

amongst other MNCH interventions