COST EFFECTIVENESS ANALYSIS OF COMMUNITY BASED PNEUMONIA TREATMENT IN RURAL DISTRICTS OF NORTH GONDAR ZONE, NORTH WEST ETHIOPIA

Abstract

Abstract Introduction: Childhood pneumonia is the biggest killer, resulting in 15% of deaths worldwide and mostly in developing countries including Ethiopia; and its treatment is associated with considerable economic costs to households. Designing and implementing better pneumonia case management strategy can reduce the burden and the treatment cost to households. Community based pneumonia case management study was conducted by enhanced community case management to increase access to pneumonia treatment (EMPIC) study researchers to assess health extension workers (HEWs) case management ability compared with other health facilities. Besides this economic evaluation can generate evidences on cost effective alternatives and inform policy makers to prioritize the efficient case management approach. Objective: Assess cost effective childhood pneumonia case management strategy (HEWs managed cases versus HEWs referral cases to other health facility) and factors associated with treatment costs in rural districts of North Gondar zone. Methods: Cost effectiveness analysis was conducted to compare HEWs managed childhood pneumonia cases (intervention) versus referred cases to health facility (control) in rural districts of North Gondar zone by using data generated from randomized control trial of EMPIC study project keeping all its ethical considerations. The cost data was collected from randomly selected 46 intervention cluster kebeles and 46 control cluster kebeles. In each cluster 202 (total 404) samples were included to this study. The collected data was entered into structured query language server; and analyzed by Stata version14 software. Using descriptive component cost effectiveness ratios were analyzed by Tree Age pro 2012 version software. Moreover factors associated with treatment cost were assessed by using log linear regression and assumptions like linearity, normality, multicolinearity and homoscedasticity were checked. Result: The average cost effectiveness ratio for intervention cluster was found to be ETB 40.62($1.4) while for control cluster ETB 74.54($2.58). The treatment outcome for both cluster arms was nearly the same, however households treatment cost was significantly higher for control cluster arm with incremental cost effectiveness ratio of ETB 33.2($1.15) per cases of treatment success. The log-linear regression model reveals that variables like source of treatment (95% CI 0.28, 0.31; log?=0.28), child age (95% CI -0.39, 0.22;

log?= -0.30), district (95% CI 0.07, 0.16; log?=0.12) and family income (95% CI 0.18, 0.34; log?=0.26) were identified as significantly associated factors to treatment cost. Conclusion and recommendation: Enhanced community case management to increase access to pneumonia treatment is a cost-effective intervention for rural communities. The government and project partners need to scale up of the strategy for rural and remote areas. Key words; cost effectiveness analysis, childhood pneumonia, treatment cost