1 research outputs found
Cost and cost-eff ectiveness of newborn home visits: fi ndings from the Newhints cluster-randomised controlled trial in rural Ghana
Background Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised
controlled trials estimated that home visits by trained community members in programme settings in Ghana and
south Asia reduced neonatal mortality by 12% (95% CI 5–18). We aimed to estimate the costs and cost-eff ectiveness of
newborn home visits in a programme setting.
Methods We prospectively collected detailed cost data alongside the Newhints trial, which tested the eff ect of a homevisits
intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI –12 to 25%) in neonatal
mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the fi rst week
of life by community-based surveillance volunteers. We calculated incremental cost-eff ectiveness ratios (ICERs) with
Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-eff ectiveness planes
and cost-eff ectiveness acceptability curves. We then modelled the potential cost-eff ectiveness for baseline neonatal
mortality rates of 20–60 deaths per 1000 livebirths with use of a meta-analysis of eff ectiveness estimates.
Findings In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) communitybased
surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in
2009. Annual economic cost of implementation was US0·53 per person. In the base-case analysis, the
Newhints intervention cost a mean of 352 (95% CI
104 to –268) per discounted life-year saved, and had a 72% chance of being highly cost eff ective with respect to
Ghana’s 2009 gross domestic product per person. Key determinants of cost-eff ectiveness were the discount rate,
protective eff ectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with
the meta-analysis results, the ICER increased from 379 per life-year saved at a rate of 20 deaths per 1000 livebirths. The strategy had at least a 99%
probability of being highly cost eff ective for lower-middle-income countries in all neonatal mortality rate scenarios
modelled, and at least a 95% probability of being highly cost eff ective for low-income countries at neonatal mortality
rates of 30 or more deaths per 1000 livebirths.
Interpretation Our fi ndings show that the seemingly modest mortality reductions achieved by a newborn home-visit
strategy might in fact be cost eff ective. In Ghana, such strategies are also likely to be aff ordable. Our fi ndings support
recommendations from WHO and UNICEF that low-income and middle-income countries implement newborn
home visits