Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial

被引:6
作者
Mori, Amani Thomas [1 ,2 ,3 ]
Kampata, Linda [1 ,2 ,4 ]
Musonda, Patrick [1 ,2 ,4 ]
Johansson, Kjell Arne [1 ,5 ]
Robberstad, Bjarne [1 ,2 ]
Sandoy, Ingvild [1 ,2 ,5 ]
机构
[1] Univ Bergen, Ctr Intervent Sci Maternal & Child Hlth, POB 7804, N-5020 Bergen, Norway
[2] Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, POB 7804, N-5020 Bergen, Norway
[3] Muhimbili Univ Hlth & Allied Sci, POB 65001, Dar Es Salaam 11103, Tanzania
[4] Univ Zambia, Sch Med, Dept Publ Hlth, Lusaka, Zambia
[5] Univ Bergen, Dept Global Publ Hlth & Primary Care, POB 7804, N-5020 Bergen, Norway
关键词
Adolescent pregnancy; Early marriage; School drop-out; Cost-benefit analysis; Extended cost-effectiveness analysis; Cash transfer; Catastrophic health expenditure; Cluster randomized controlled trial; MIDDLE-INCOME COUNTRIES; LOW-BIRTH-WEIGHT; ECONOMIC-EVALUATION; TEENAGE PREGNANCY; SCHOOL DROPOUT; MATERNAL AGE; HEALTH; DISEASES; PRETERM; CHILDBEARING;
D O I
10.1186/s13063-017-2350-4
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. Methods: The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. Discussion: While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be considered seriously when evaluating whether such a program can justify the required investments in a setting with scarce resources. The economic evaluations outlined in this paper will generate valuable information that can be used to guide large-scale implementation of programs to address the problem of the high prevalence of adolescent childbirth and school drop-outs in similar settings.
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页数:10
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共 50 条
[1]   Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network's Maternal Newborn Health Registry study [J].
Althabe, Fernando ;
Moore, Janet L. ;
Gibbons, Luz ;
Berrueta, Mabel ;
Goudar, Shivaprasad S. ;
Chomba, Elwyn ;
Derman, Richard J. ;
Patel, Archana ;
Saleem, Sarah ;
Pasha, Omrana ;
Esamai, Fabian ;
Garces, Ana ;
Liechty, Edward A. ;
Hambidge, K. Michael ;
Krebs, Nancy F. ;
Hibberd, Patricia L. ;
Goldenberg, Robert L. ;
Koso-Thomas, Marion ;
Carlo, Waldemar A. ;
Cafferata, Maria L. ;
Buekens, Pierre ;
McClure, Elizabeth M. .
REPRODUCTIVE HEALTH, 2015, 12
[2]  
[Anonymous], 2007, NEW INSIGHTS PREVENT
[3]  
[Anonymous], 2014, ZAMB DEM HLTH SURV 2
[4]   Methods for analyzing cost effectiveness data from cluster randomized trials [J].
Bachmann M.O. ;
Fairall L. ;
Clark A. ;
Mugford M. .
Cost Effectiveness and Resource Allocation, 5 (1)
[5]  
Boardman A.E., 2014, COST BENEFIT ANAL CO
[6]   Power and sample size calculations for stochastic cost-effectiveness analysis [J].
Briggs, AH ;
Gray, AM .
MEDICAL DECISION MAKING, 1998, 18 (02) :S81-S92
[7]  
Central Statistical Office, 2011, LIV COND MON SURV RE
[8]  
Chaaban J., 2008, 7 MIDDL E YOUTH IN
[9]  
Chaaban J., 2011, MEASURING EC GAIN IN
[10]   Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study [J].
Chen, Xi-Kuan ;
Wen, Shi Wu ;
Fleming, Nathahe ;
Demissie, Kitaw ;
Rhoads, George G. ;
Walker, Mark .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 2007, 36 (02) :368-373