ICCM CEA
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Blue cells are adjustable inputs
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CEA for iCCM in Ghana, based on Chinbuah et al 2012ValueSourceNotes
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Costs of 4 year program in Chinbuah et al 2012 (in 2009 USD)$203,172.75
@Nonvignon et al 2012@
"The total direct economic costs of the study interventions were US$ 154 411.12 and US$ 203 172.75 for AAQ (Table 2a) and AAQ + AMX (Table 2b), respectively." Pg 954; "Direct costs. Direct costs had capital and recurrent components. Capital costs included vehicles and equipment that were annualised using the useful life of items and the recommended discount rate of 3% (Gold et al. 1996). The useful life of capital was estimated on the basis of the discussion with the accountant and the stores manager at the DHRC. The capital items were vehicles, motorcycles and helmets, television sets, flip chart stands, generators, digital camera, DVD players, VCDs and extension equipment. Recurrent costs included medical supplies (e.g. drugs), stationery supplies, allowances and salaries of staff involved in programme activities, and cost of vehicle operation and maintenance. Market rental price was used for building spaces. Capital costs and recurrent costs were summed up to obtain the total costs for each study year. These costs were then apportioned to the two study arms using the proportion of CHWs and number of communities under each study arm. However, the cost of drugs that were specific to a particular study arm was allocated to the respective study arm.
Indirect costs. Indirect costs constitute productivity losses. This included the time of CHWs (who were not remunerated) volunteered to the trial. Also, the productive losses to caregivers (travel and treatment time) were included. Indirect costs were analysed using the average local agricultural labour wage per day."
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Inflation calculator1.13CPI calculator: http://data.bls.gov/cgi-bin/cpicalc.pl
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Costs of program in Chinbuah et al 2012 (in 2016 USD)$229,585.21Calculation
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Increase costs by a factor of X given early stage of CEA1
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No of children4,043
@Chinbuah et al 2012@
"Figure 2. Cluster and participant flow after first randomization."
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CHWs119
@Chinbuah et al 2012@
"Figure 2. Cluster and participant flow after first randomization."
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Children per CHW33.97478992
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Cost per capita per year$14.20
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Average under five mortality rate during years of the trial0.080975
http://data.worldbank.org/indicator/SH.DYN.MORT?end=2009&locations=GH&start=2006
"Mortality rate, under-5 (per 1,000 live births)" "GHANA" - 84.4 (2006), 82.2 (2007), 79.9 (2008), 77.4 (2009)
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Average under five mortality rate 20150.0616
http://data.worldbank.org/indicator/SH.DYN.MORT?end=2015&locations=GH&start=2015
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Deaths averted 79.9
@Nonvignon et al 2012@
"The number of deaths observed during the trial period were 181 (control), 72 (AAQ) and 57 (AAQ + AMX). Records of these deaths were obtained from the trial records and the Health and Demographic Surveillance System (HDSS), which is a biannual census that obtains data on vital events such as deaths, births and pregnancies. However, for the purpose of estimating the cost-effectiveness of the trial interventions, the indirect standardization method (Kirkwood & Sterne 2005, pp. 268 & 269) was used to calculate the expected number of deaths in AAQ and AAQ + AMX with the control as the reference population.
The method made use of the observed age-specific deaths and person years in each study arm. The expected deaths in
AAQ and AAQ + AMX were estimated to be 101.9 and 101.3, respectively. Originally developed in 1990, DALYs are a measure of the burden of diseases and are expressed as number of years of life lost to illness and years lived with disability (YLD). Years of life lost (YLL) is a component of DALY and constitutes the majority of the burden of fever (especially malaria). Using life expectancy at a mean age of death of 65.4 years (Ghana Statistical Service 2011), no age weighting and a discount rate of 3% (Murray & Lopez 1996a,b), each death was estimated to be equivalent to 28.6 YLLs. The differences between the effects (i.e. anaemia cases, deaths and DALYs) under each study arm and those under the control constituted the final effects"
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Replicability1.00
Note our IIR: "In Burkina Faso, a cluster randomized controlled trial of iCCM for fever and pneumonia (38 clusters, 76,000 HHs) found a difference in difference estimate of the mortality rate ratio among children aged 2–59 months of 0.95 (0.57–1.59), which was not statistically significant.13 We have not found a published version of this study." Study was approximately 3x as large
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External validity0.76Calculated as U5MR 2015/U5MR during trial
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Cost per death averted$3,777.18Calculation
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CEA based on Chinbuah et al 2012
Effect sizes for CE threshold in SSA
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Living goods estimates
 
 
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