Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

Abstract Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization...

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Autores principales:	Lecia Brown, Alan Martin, Christopher Were, Nandita Biswas, Alexander Liakos, Elena DeAngelis, Lee Alexandra Evitt
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Chlorhexidine dry cord care Kenya omphalitis cost-consequence Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/7283f03225304350a3057f1971fca373
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spelling	oai:doaj.org-article:7283f03225304350a3057f1971fca3732021-11-21T12:06:14ZCost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya10.1186/s12913-021-06971-71472-6963https://doaj.org/article/7283f03225304350a3057f1971fca3732021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-06971-7https://doaj.org/toc/1472-6963Abstract Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.Lecia BrownAlan MartinChristopher WereNandita BiswasAlexander LiakosElena DeAngelisLee Alexandra EvittBMCarticleChlorhexidinedry cord careKenyaomphalitiscost-consequencePublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Chlorhexidine dry cord care Kenya omphalitis cost-consequence Public aspects of medicine RA1-1270
spellingShingle	Chlorhexidine dry cord care Kenya omphalitis cost-consequence Public aspects of medicine RA1-1270 Lecia Brown Alan Martin Christopher Were Nandita Biswas Alexander Liakos Elena DeAngelis Lee Alexandra Evitt Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
description	Abstract Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.
format	article
author	Lecia Brown Alan Martin Christopher Were Nandita Biswas Alexander Liakos Elena DeAngelis Lee Alexandra Evitt
author_facet	Lecia Brown Alan Martin Christopher Were Nandita Biswas Alexander Liakos Elena DeAngelis Lee Alexandra Evitt
author_sort	Lecia Brown
title	Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_short	Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_full	Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_fullStr	Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_full_unstemmed	Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_sort	cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in kenya
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7283f03225304350a3057f1971fca373
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Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

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