Abstract
BackgroundWhile evidence-based recommendations for the management of under-five pneumonia at the community level were made by the World Health Organisation, the implementation remains poor in Nigeria. Initiatives to promote the integrated community case management (iCCM) of pneumonia through the proprietary and patent medicine vendors (PPMVs) have been poorly utilized possibly due to low financial support and perceived benefit. This study provides cost and benefit estimates and implications of promoting the iCCM through the PPMVs’ education and support. The outcome of this study will help inform healthcare decisions in Nigeria. MethodsThis study was a cost-benefit analysis using simulation-based decision-analytic Markov model. Two approaches were compared, the current scenario which is the use of amoxicillin dispersible tablet (DT) and amoxicillin DT plus promotion. Health outcomes include disability-adjusted life years averted (converted to monetary benefit) and severe pneumonia hospitalisation cost averted. Both the cost and benefit were expressed in 2018 US dollars. ResultsThe incremental benefit-cost ratio of promoting the iCCM was 1.37, while the total net-benefit was $3.31 (95% CI: $2.08 – 4.76) million from the whole country perspective, which will offset over three-quarter of the promotion cost. Implementing the promotion exercise at a cost above $6.82 million will not be a worthwhile decision. ConclusionPromoting the iCCM for the treatment of pneumonia in children under-five through education and support of the PPMVs holds promises to harness the benefits amoxicillin DT and provide a high return on investment. A nationwide promotion exercise should be considered especially in remote areas of the country.
AB1111 A prospective cohort study measuring cost-benefit analysis of the otago exercise programme in community dwelling adults with rheumatoid arthritis
