A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

<h4>Background</h4>To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost...

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Autores principales:	Edwine W Barasa, Philip Ayieko, Susan Cleary, Mike English
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/52f640ea352441549eb52c922ee9be61
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spelling	oai:doaj.org-article:52f640ea352441549eb52c922ee9be612021-11-18T05:42:14ZA multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.1549-12771549-167610.1371/journal.pmed.1001238https://doaj.org/article/52f640ea352441549eb52c922ee9be612012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22719233/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.<h4>Methods and findings</h4>Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3.<h4>Conclusion</h4>Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost-effective when compared to incremental cost-effectiveness ratios of other priority child health interventions.Edwine W BarasaPhilip AyiekoSusan ClearyMike EnglishPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 9, Iss 6, p e1001238 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Edwine W Barasa Philip Ayieko Susan Cleary Mike English A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
description	<h4>Background</h4>To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.<h4>Methods and findings</h4>Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3.<h4>Conclusion</h4>Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost-effective when compared to incremental cost-effectiveness ratios of other priority child health interventions.
format	article
author	Edwine W Barasa Philip Ayieko Susan Cleary Mike English
author_facet	Edwine W Barasa Philip Ayieko Susan Cleary Mike English
author_sort	Edwine W Barasa
title	A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
title_short	A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
title_full	A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
title_fullStr	A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
title_full_unstemmed	A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.
title_sort	multifaceted intervention to improve the quality of care of children in district hospitals in kenya: a cost-effectiveness analysis.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/52f640ea352441549eb52c922ee9be61
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A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

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