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Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

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  • Charles E Okafor
  • Obinna I Ekwunife

Abstract

Background: Diarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the ‘no treatment’ approach (NT); the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI); and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI). Methods: Markov cohort model conducted from the payer’s perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state). Disability adjusted life years (DALYs) averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER) served as measure of cost-effectiveness. Results: Based on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita), all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation. Conclusion: Rotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria. Author summary: ‘‘Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: a decision analytical model” was an original research carried out due to the high prevalence and mortality rate due to diarrhoea in Nigeria. The study aims to determine which treatment approach for diarrhoea would be cost-effective for Nigerians to implement due to limited resources available. Rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI) was the most cost-effective treatment approach.

Suggested Citation

  • Charles E Okafor & Obinna I Ekwunife, 2017. "Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(12), pages 1-14, December.
    • Handle: RePEc:plo:pntd00:0006124
    DOI: 10.1371/journal.pntd.0006124
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.
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