1. Improving the Quality of Care of Sick Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis Barasa W. E, Ayieko P, Cleary S, English M

2. Background • Under 5 mortality continues to be a challenge globally • In Kenya the under 5 mortality rate needs to reduce by 50% to meet the MDG 4 target • The district hospital is an important avenue for delivering cost-effective child health interventions • The quality of care in these hospitals has however been found to be poor in Kenya • A multifaceted intervention to improve inpatient care in these hospital was tested and found to be effective. • We present here a cost effectiveness analysis of the intervention

3. The Intervention

4. Objectives and Methods Objectives • To determine the total economic costs of delivering ETAT+ • To assess the cost effectiveness of the intervention • To model the costs of scale up of ETAT+ to a national level Methods • A cost-effectiveness analysis (CEA) alongside a cRCT • Provider perspective • Horizon – 18 months (Sep 2006 – Apr 2008) • One way sensitivity analysis conducted on development & hotel costs, effectiveness and salaries

5. Methods Sample sizes • Process of care: 1158 & 1157 at 18 months in intervention and control hospitals respectively • Resource use: 6199 & 5115 in intervention and control hospitals respectively Measuring costs • An ingredients approach • Costs of developing, implementing and treatment where evaluated Measuring effectiveness • Quality of care measured using process of care that span assessment, diagnosis and treatment

6. Assessing Costs-Effectiveness • Intervention study not designed to measure mortality as a primary outcome • The ICER was defined as the incremental cost per % improvement in QoC • We also assessed likely cost per DALY averted estimates assuming plausible relative reductions in baseline inpatient mortality rate (7%) of between 1% and 10% • This corresponds to absolute reductions in mortality of between 0.07% and 0.7%

7. Results: Intervention Costs Summary

8. Results: Incremental Cost-Effectiveness Ratio • The additional cost per 1 percentage improvement in quality of care (ICER) was US$ 0.78 per child admission

9. Results: Estimated Costs of Scale-up • Total costs of scale-up are US$ 3,633,123.45

10. Results: “What-If” Analysis

11. ICERs of other Key Child health Interventions

12. Discussions: Should ETAT+ be scaled up? • There is therefore a strong case to scale up ETAT+ amongst other MNCH interventions