Economic and cost-effectiveness analysis of the Community-Level Interventions for Pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique.

Abstract

BACKGROUND:

The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.

METHODS:

Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1-3, 4-7, ≥8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision tree model was built to determine the cost-effectiveness of the intervention (vs usual care), based on the primary clinical endpoint of years of life lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes.

RESULTS:

The incremental per pregnancy cost of the intervention was US$12.66 (India), US$11.51 (Pakistan) and US$13.26 (Mozambique). As implemented, the intervention was not cost-effective due largely to minimal differences in YLL between arms. However, among women who received ≥8 CLIP contacts (four in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries).

CONCLUSION:

The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting WHO guidance on antenatal contact frequency.

TRIAL REGISTRATION NUMBER:

NCT01911494.

• Authors: Jeffrey N Bone, Asif R Khowaja, Marianne Vidler, Beth A Payne, Mrutyunjaya B Bellad, Shivaprasad S Goudar, Ashalata A Mallapur, Khatia Munguambe, Rahat N Qureshi, Charfudin Sacoor, Esperanca Sevene, Geert W J Frederix, Zulfiqar A Bhutta, Craig Mitton, Laura A Magee, Peter von Dadelszen, CLIP Trials Working Group
• Journal: BMJ global health (BMJ Glob Health) Vol. 6 Issue 5 (05 2021) ISSN: 2059-7908 [Print] England
• PMID: 34031134 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Topics

• Cost-Benefit Analysis
• Female
• Humans
• India (epidemiology)
• Infant
• Mozambique (epidemiology)
• Pakistan (epidemiology)
• Pre-Eclampsia (epidemiology, therapy)
• Pregnancy