scholarly journals Incremental cost and cost-effectiveness of low-dose, high-frequency training in basic emergency obstetric and newborn care as compared to status quo: part of a cluster-randomized training intervention evaluation in Ghana

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Michelle Willcox ◽  
Heather Harrison ◽  
Amos Asiedu ◽  
Allyson Nelson ◽  
Patricia Gomez ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
High Frequency ◽  
Low Dose ◽  
Newborn Care ◽  
Status Quo ◽  
Training Intervention ◽  
Intervention Evaluation ◽  
Cluster Randomized

scholarly journals Cost-Effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression – a cluster-randomized trial

2020 ◽  
Author(s):  
Christian Brettschneider ◽  
Daniela Heddaeus ◽  
Maya Steinmann ◽  
Martin Härter ◽  
Birgit Watzke ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Controlled Trial ◽  
Treatment Guideline ◽  
Stepped Care ◽  
Control Group ◽  
Care Model ◽  
Treatment As Usual ◽  
Life Years ◽  
Cluster Randomized

Abstract Objective Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped-care model based on the German National Clinical Practice Guideline “Unipolar Depression” has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus standard care in depression. Methods This prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D as effect measure. Resource utilization was assessed by patient questionnaires. We calculated adjusted group differences in costs and effects, incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. The complete sample and subgroups based on depression severity were considered. Results In the IG, adjusted mean total costs (+5,016; SE: €2,691) and effects (+0.008 QALY; SE: 0.02) were higher than in the CG; yet, differences were not statistically significant. Significantly increased costs were found in the IG for outpatient physician services and psychiatrist services. Significantly increased total and indirect costs in the IG were found in the group with severe depression. Incremental cost-effectiveness ratios were unfavourable and the probability of cost-effectiveness was low, except for the group with moderate depression (70% for willingness-to-pay threshold of €50,000/QALY). Conclusions We found no evidence for cost-effectiveness of the intervention. However, we identified indicators that the intervention works according to the aims of the National Treatment Guideline.

scholarly journals A mixed-methods evaluation of a cluster randomized controlled trial on simulation-based low-dose, high-frequency plus mobile mentoring training versus traditional group-based training of health workers in Ebonyi and Kogi States, Nigeria

2019 ◽  
Author(s):  
EMMANUEL UGWA ◽  
Mark Kabue ◽  
Emmanuel Otolorin ◽  
Gayane Yenokyan ◽  
Adetiloye Oniyire ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Frequency ◽  
Low Dose ◽  
Health Workers ◽  
Controlled Trial ◽  
Traditional Group ◽  
Knowledge And Skills ◽  
Randomized Controlled ◽  
Simulation Based ◽  
Cluster Randomized

Abstract Background: There are few studies from low- and middle-income countries on learning outcomes among health workers who have been trained on day of birth care using onsite, simulation-based, low-dose, high frequency (LDHF) training plus mobile (m) mentoring. The aim of this study was to compare their knowledge and skills competencies with those of health workers trained using the traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods: We conducted a prospective cluster randomized controlled trial, enrolling 299 health workers in 60 health facilities in Kogi and Ebonyi states, randomized to either LDHF/m-mentoring (intervention, n=30 facilities) or traditional group-based training (TRAD, n=30 facilities) control arm. Health workers in both arms received basic emergency obstetric and newborn care training with simulated practice using anatomic models and role-plays. The control arm participants were trained offsite while the intervention arm were trained onsite where they work. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions and objective structured clinical examinations mean scores were compared; p-value <0.05 was considered statistically significant. Qualitative data were collected and analyzed along themes of interest. Results: The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at endline (p <0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p<0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion: The LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.

Cost-effectiveness of the Yashoda Programme

2017 ◽  
Vol 19 (2) ◽  
pp. 255-263 ◽  
Author(s):  
Somen Saha ◽  
Beena Varghese
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Neonatal Mortality ◽  
Intervention Group ◽  
Newborn Care ◽  
Additional Cost ◽  
Potential Cost ◽  
Neonatal Deaths ◽  
District Hospitals ◽  
Care Practices

Background: Under the Norway-India Partnership Initiative (NIPI), a pilot programme was launched in 2008 to improve the quality of institutional maternal and neonatal care through Yashodas or birth companions. Yashodas were placed at higher-level healthcare facilities across select districts of India to support mother and newborn. This article presents the additional cost of the Yashoda programme from a government perspective and models the potential cost-effectiveness of the Yashoda intervention in averting neonatal deaths. Methods: We estimated the additional costs of the Yashoda programme (2011–2012) using an activity-based costing approach from a provider perspective. Effectiveness measure was estimated as the difference in the average rate of receipt of counselling (for mothers who delivered at district hospitals) between intervention and comparison districts. The potential impact of the Yashoda programme on neonatal mortality was modelled from secondary data assuming a 30 per cent reduction in neonatal mortality among those who received counselling and practiced safe newborn care practices. Results: The additional cost of Yashoda intervention was US$26,350 per year or US$0.83 per live birth. Eighty-four per cent of mothers in the intervention group received essential postpartum newborn care counselling at the facility compared to 62 per cent of mothers in the comparison groups. Through potential change in newborn care practices, the Yashoda intervention was estimated to avert 45 neonatal deaths for a hypothetical cohort of 100,000 mothers who delivered at district hospitals. The incremental cost of the Yashoda intervention was US$1,832 per neonatal death averted or US$29 per life year saved (LYS). Sensitivity analysis showed the incremental cost per LYS of the Yashoda intervention varied between US$14 and US$59. Conclusion: This study concludes that the Yashoda intervention, when scaled up at high delivery load facilities, is a very cost-effective intervention to save newborn lives.

scholarly journals Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

2021 ◽  
Vol 6 (12) ◽  
pp. e007168
Author(s):  
Angela Kairu ◽  
Vincent Were ◽  
Lynda Isaaka ◽  
Ambrose Agweyu ◽  
Samuel Aketch ◽  
...  
Keyword(s):  
Critical Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Incremental Cost ◽  
Resource Scarcity ◽  
Status Quo ◽  
Healthcare Provision ◽  
Tree Model ◽  
System Perspective ◽  
The Cost

BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions.MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results.ResultsThe status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya’s cost-effectiveness threshold (US$908).ConclusionWhen the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.

scholarly journals Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers in Nigeria; a cluster randomized controlled trial

2020 ◽  
Author(s):  
EMMANUEL UGWA ◽  
Mark Kabue ◽  
Emmanuel Otolorin ◽  
Gayane Yenokyan ◽  
Adetiloye Oniyire ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Frequency ◽  
Low Dose ◽  
Health Workers ◽  
Controlled Trial ◽  
Traditional Group ◽  
Knowledge And Skills ◽  
Randomized Controlled ◽  
Simulation Based ◽  
Cluster Randomized

Abstract Background: The aim of this study was to compare health workers knowledge and skills competencies between those trained using the onsite simulation-based, low-dose, high frequency (LDHF) training plus mobile (m) mentoring and the ones trained using the traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods: A prospective cluster randomized controlled trial was conducted by enrolling 299 health workers in 60 health facilities in Kogi and Ebonyi states, randomized to either LDHF/m-mentoring (intervention, n=30 facilities) or traditional group-based training (TRAD, n=30 facilities) control arm. These health workers in both arms received basic emergency obstetric and newborn care training with simulated practice using anatomic models and role-plays. The control arm was trained offsite while the intervention arm was trained onsite where they worked. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions and objective structured clinical examinations mean scores were compared; p-value <0.05 was considered statistically significant. Qualitative data were collected and content analysis was done. Results: The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at endline (p <0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p<0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion: The LDHF/m-mentoring intervention is more effective than TRAD approach in improcquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.

scholarly journals Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

2021 ◽  
Author(s):  
Angela Kairu ◽  
Vincent Were ◽  
Lynda Isaaka ◽  
Ambrose Agweyu ◽  
Samuel Aketch ◽  
...  
Keyword(s):  
Critical Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Incremental Cost ◽  
Cost Effective ◽  
Resource Scarcity ◽  
Status Quo ◽  
Tree Model ◽  
System Perspective ◽  
The Cost

Background: Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization of investment decisions. Methods: We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and advanced critical care (EC+ACC) compared to current health care provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of the results. Results: The status quo option is more costly and less effective compared to investment in essential care and is thus dominated by the later. The incremental cost effectiveness ratio (ICER) of Investment in essential and advanced critical care (EC+ACC) was US $1,378.21 per DALY averted and hence not a cost-effective strategy when compared to the Kenyan cost-effectiveness threshold (USD 908). Conclusion: When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritizes investments in essential care before investments in advanced critical care. This information on cost-effectiveness will however need to be considered as part of a multi-criteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society. Keywords: COVID-19, cost-effectiveness, essential care, advanced critical care, Kenya

scholarly journals Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers in Ebonyi and Kogi States, Nigeria; a cluster randomized controlled trial

2020 ◽  
Author(s):  
EMMANUEL UGWA ◽  
Mark Kabue ◽  
Emmanuel Otolorin ◽  
Gayane Yenokyan ◽  
Adetiloye Oniyire ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Frequency ◽  
Low Dose ◽  
Health Workers ◽  
Controlled Trial ◽  
Traditional Group ◽  
Knowledge And Skills ◽  
Randomized Controlled ◽  
Simulation Based ◽  
Cluster Randomized

Abstract Background: There are few studies from low- and middle-income countries on learning outcomes among health workers trained on day of birth care using onsite, simulation-based, low-dose, high frequency (LDHF) training plus mobile (m) mentoring. The aim of this study was to compare their knowledge and skills competencies with those of health workers trained using the traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods: We conducted a prospective cluster randomized controlled trial, enrolling 299 health workers in 60 health facilities in Kogi and Ebonyi states, randomized to either LDHF/m-mentoring (intervention, n=30 facilities) or traditional group-based training (TRAD, n=30 facilities) control arm. Health workers in both arms received basic emergency obstetric and newborn care training with simulated practice using anatomic models and role-plays. The control arm participants were trained offsite while the intervention arm were trained onsite where they work. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions and objective structured clinical examinations mean scores were compared; p-value <0.05 was considered statistically significant. Qualitative data were collected and analyzed along themes of interest. Results: The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at endline (p <0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p<0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion: The LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.

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