Cost-effectiveness analysis of a large-scale creche intervention to prevent child drowning in rural Bangladesh

Background Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale creche (daycare) intervention in preventing child drowning. Methods The cost of the creches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the creches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective. Results From the program perspective the annual operating cost of a creche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the creches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was - $166,833 (95% CI: - $197,421 to - $141,341)-meaning creches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the creche intervention was cost-effective even when the societal economic benefits were ignored. Conclusions Based on the evidence, the creche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable.