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1. Sabin LL, Knapp AB, MacLeod WB, Phiri-Mazala G, Kasimba J, Hamer DH, Gill CJ: Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP). PLoS One; 2012;7(4):e35560

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).
  • BACKGROUND: The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%.
  • This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness.
  • METHODS AND FINDINGS: We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020).
  • In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars.
  • The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios.
  • Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis.
  • The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year.
  • Fixed costs accounted for nearly 90% of total costs.
  • For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively.
  • Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.
  • CONCLUSIONS: Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'.
  • We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.
  • [MeSH-major] Infant Mortality. Midwifery / economics. Midwifery / education
  • [MeSH-minor] Cost-Benefit Analysis. Female. Humans. Infant, Newborn. Multivariate Analysis. Pregnancy. Zambia

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  • (PMID = 22545117.001).
  • [ISSN] 1932-6203
  • [Journal-full-title] PloS one
  • [ISO-abbreviation] PLoS ONE
  • [Language] eng
  • [Grant] United States / NIAID NIH HHS / AI / K23 AI062208; United States / NIAID NIH HHS / AI / K23 AI 62208; United States / Intramural NIH HHS / /
  • [Publication-type] Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC3335866
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