Related Experiment Video
Updated: May 7, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh
Amnesty E LeFevre1, Samuel D Shillcutt, Hugh R Waters
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Suite E-8139, 615 North Wolfe Street, Baltimore MD 21205, United States of America (USA).
Insights
The home-care package significantly reduced neonatal deaths, proving highly cost-effective for improving infant survival. Community care strategies did not demonstrate similar benefits in Bangladesh.
Area of Science:
- Global Health
- Health Economics
- Neonatal Medicine
Background:
- Neonatal mortality remains a significant global health challenge, particularly in low-resource settings.
- Effective and affordable interventions are crucial for reducing preventable newborn deaths.
Purpose of the Study:
- To compare the cost-effectiveness of two neonatal care strategies: home care and community care.
- To evaluate these strategies against existing maternal and neonatal care services in Sylhet, Bangladesh.
Main Methods:
- A cluster-randomized controlled trial was conducted.
- Economic costs were assessed from a societal perspective, including program, provider, and household costs.
- Neonatal mortality was determined via household surveys, and incremental cost-effectiveness ratios (ICERs) were calculated.
Main Results:
- The home-care package demonstrated significant cost-effectiveness, averting neonatal deaths at US$2939 and disability-adjusted life years (DALYs) at US$103.49.
- The home-care strategy was cost-effective with 95% certainty if healthy life years were valued above US$214 per DALY.
- The community-care strategy did not reduce neonatal mortality and was not found to be cost-effective.
Conclusions:
- The home-care package is a highly cost-effective intervention for neonatal care.
- This strategy shows potential for replication and scale-up in similar settings globally.
Objective:
To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh.
Methods:
In a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy--compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis.
Findings:
The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$ 103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$ 104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective.
Conclusion:
The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...