Cost-effectiveness and economic returns of group-based parenting interventions to promote early childhood development: Results from a randomized controlled trial in rural Kenya.
Cost-effectiveness and economic returns of group-based parenting interventions to promote early childhood development: Results from a randomized controlled trial in rural Kenya.
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成本效益和经济回报的组为基础的养育干预措施，以促进儿童早期发展：结果来自肯尼亚农村的随机对照试验。
DOI：
10.1371/journal.pmed.1003746
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发表时间：
2021-09
期刊：
影响因子：
15.8
通讯作者：
Luoto JE
中科院分区：
文献类型：
--
作者：
Lopez Garcia I;Saya UY;Luoto JE
幼儿发展 (ECD) 计划可以帮助解决低收入和中等收入国家 (LMIC) 中 43% 的 5 岁以下儿童发展受损的问题。然而，中低收入国家的研究很少包含有关其计划的成本效益或潜在投资回报的信息。我们评估了利用肯尼亚当地社区健康志愿者 (CHV) 网络的 ECD 育儿干预的 2 种有效的基于团体的实施模式的成本效益、效益成本比 (BCR) 和投资回报 (ROI)。 2018年10月1日至11月12日期间，对肯尼亚西部农村60个村庄的1,152名带着6至24个月大孩子的母亲进行了调查。基线后，村庄被随机分配到 3 个干预组之一：每两周进行 16 次会议的纯小组交付模式，结合 12 次小组会议和 4 次家访的混合交付模式，以及对照组。在终点（2019 年 8 月 5 日至 10 月 31 日），1,070 名儿童被保留并评估主要结局，包括认知和接受性语言发展（使用婴儿发展贝利量表，第三版）和社会情感发展（使用沃尔克量表）。两个干预组的儿童比对照组的儿童表现出更好的发育结果，尽管仅团体分娩模式通常对儿童产生更大的影响。项目总成本包括提供者在干预期间使用当地非政府组织 (NGO) 实施者的财务报告收集的实施成本，以及社会成本，例如母亲和助产士的机会成本。我们将项目影响与这些总成本相结合，根据对未来终生工资和社会成本的预测来估计增量成本效益比 (ICER) 以及 BCR 和项目的投资回报率。仅团体交付组中每个儿童的总费用为 140 美元，混合交付组中每个孩子的总费用为 145 美元。由于意向治疗 (ITT) 影响较高且成本稍低，因此仅针对团体的模型在所有儿童结果中是最具成本效益的。我们重点关注该手臂的儿童认知能力，估计每投资 100 美元，认知能力 ICER 提高 0.37 标准差 (SD)，BCR 为 15.5，投资回报率为 127%。我们研究的一个局限性是，我们估计的 BCR 和 ROI 必然对贴现率、所得税率以及干预对未来工资和教育影响的预测做出假设。我们检查我们的结果对这些假设的敏感性。据我们所知，这项研究是对针对撒哈拉以南非洲 (SSA) 幼儿的有效 ECD 育儿干预措施的首次经济评估，也是首次采用社会视角来计算成本效益，考虑到交付代理人和项目参与者的机会成本。我们的成本效益和效益成本估计高于中低收入国家先前提供成本信息的有限研究中的大多数。我们的结果为在贫困农村地区扩大类似干预措施提供了有力的依据，并且在对未来的合理假设下，表明此类投资的私人和社会回报可能会大大超过其成本。该试验于 2018 年 6 月 7 日在 ClinicalTrials.gov 注册，NCT03548558。美国经济协会 RCT 注册试验 AEARCTR-0002913。 Italo Lopez Garcia 及其同事对有效的育儿干预措施进行了经济评估，以促进肯尼亚 3 岁以下儿童的认知、接受性语言和社会情感发展。据估计，由于贫困、缺乏刺激和营养缺乏，低收入和中等收入国家 (LMIC) 的 5 岁以下儿童中有 43% 面临成年后无法充分发挥发育潜力的风险。许多儿童早期发展 (ECD) 育儿干预措施教导家长改善儿童反应性刺激和营养实践的策略，这些干预措施已证明它们可以帮助改善儿童的学习成果。然而，很少有儿童早期发展育儿研究分享有关其项目成本的信息，以便分析其成本效益或潜在经济回报，这对于决定是否投资儿童早期发展育儿项目至关重要。在报告项目成本效益的极少数研究中，没有一项研究考虑了项目参与者为参加项目并实施任何建议的行为改变而必须承担的机会成本。我们计算了总成本、成本效益，并比较了最近在肯尼亚西部农村 60 个村庄（涉及近 1,200 名母亲及其幼儿）测试的 ECD 育儿干预措施的收益与成本。该计划比较了两种不同的交付模式，一种仅在村庄内进行团体访问，另一种则采用团体和家访相结合的方式。两者均由当地社区卫生志愿者 (CHV) 在 8 个月内提供。我们估算了两种交付模式下 CHV 和项目参与者的机会成本，并预测参与带来的未来收益和成本，例如终生工资和教育成本的增加。我们发现，在两种交付模式下，儿童的认知发展都以非常合理的成本得到了很大的改善，但仅团体模式是最具成本效益的。在对未来的合理假设下，我们发现长期计划收益可能超过其相关成本 15 倍，这意味着愿意扩大该计划的政府将获得巨大的潜在投资回报 (ROI)。我们的研究结果对于资源匮乏和农村地区的儿童早期发展育儿计划的投资非常令人鼓舞。随着国家和国际政策制定者越来越多地鼓励对幼儿早期发展育儿计划的投资，我们的研究结果为实现这一目标提供了有力的案例研究。
Early childhood development (ECD) programs can help address disadvantages for the 43% of children under 5 in low- and middle-income countries (LMICs) experiencing compromised development. However, very few studies from LMIC settings include information on their program’s cost-effectiveness or potential returns to investment. We estimated the cost-effectiveness, benefit–cost ratios (BCRs), and returns on investment (ROIs) for 2 effective group-based delivery models of an ECD parenting intervention that utilized Kenya’s network of local community health volunteers (CHVs). Between October 1 and November 12, 2018, 1,152 mothers with children aged 6 to 24 months were surveyed from 60 villages in rural western Kenya. After baseline, villages were randomly assigned to one of 3 intervention arms: a group-only delivery model with 16 fortnightly sessions, a mixed-delivery model combining 12 group sessions with 4 home visits, and a control group. At endline (August 5 to October 31, 2019), 1,070 children were retained and assessed for primary outcomes including cognitive and receptive language development (with the Bayley Scales of Infant Development, Third Edition) and socioemotional development (with the Wolke scale). Children in the 2 intervention arms showed better developmental outcomes than children in the control arm, although the group-only delivery model generally had larger effects on children. Total program costs included provider’s implementation costs collected during the intervention period using financial reports from the local nongovernmental organization (NGO) implementer, as well as societal costs such as opportunity costs to mothers and delivery agents. We combined program impacts with these total costs to estimate incremental cost-effectiveness ratios (ICERs), as well as BCRs and the program’s ROI for the government based on predictions of future lifetime wages and societal costs. Total costs per child were US$140 in the group-only arm and US$145 in the mixed-delivery arm. Because of higher intention-to-treat (ITT) impacts at marginally lower costs, the group-only model was the most cost-effective across all child outcomes. Focusing on child cognition in this arm, we estimated an ICER of a 0.37 standard deviation (SD) improvement in cognition per US$100 invested, a BCR of 15.5, and an ROI of 127%. A limitation of our study is that our estimated BCR and ROI necessarily make assumptions about the discount rate, income tax rates, and predictions of intervention impacts on future wages and schooling. We examine the sensitivity of our results to these assumptions. To the best of our knowledge, this study is the first economic evaluation of an effective ECD parenting intervention targeted to young children in sub-Saharan Africa (SSA) and the first to adopt a societal perspective in calculating cost-effectiveness that accounts for opportunity costs to delivery agents and program participants. Our cost-effectiveness and benefit–cost estimates are higher than most of the limited number of prior studies from LMIC settings providing information about costs. Our results represent a strong case for scaling similar interventions in impoverished rural settings, and, under reasonable assumptions about the future, demonstrate that the private and social returns of such investments are likely to largely outweigh their costs. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. American Economic Association RCT Registry trial AEARCTR-0002913. Italo Lopez Garcia and colleagues conduct an economic evaluation of an effective parenting intervention to promote cognitive, receptive language, and socioemotional development among children under 3 years in Kenya. It is estimated that 43% of children under 5 years of age from low- and middle-income countries (LMICs) are at risk of not reaching their full developmental potential as adults due to poverty, lack of stimulation, and nutritional deficiencies. Numerous early childhood development (ECD) parenting interventions that teach parents strategies to improve responsive stimulation and nutritional practices with children have demonstrated that they can help improve children’s outcomes. Yet very few ECD parenting studies have shared information about their program’s costs to enable an analysis of its cost-effectiveness or potential economic returns, which is crucial to inform policy decisions on whether to invest in ECD parenting programs. Among the very few studies that report a program’s cost-effectiveness, none has accounted for the opportunity costs that program participants must incur to attend a program and enact any recommended behavioral changes. We calculate the total costs, cost-effectiveness, and compare the benefits versus costs for an ECD parenting intervention recently tested across 60 villages in rural western Kenya involving nearly 1,200 mothers and their young children. The program compared 2 different delivery models, one featuring only group visits within villages and a second featuring a combination of group and home visits. Both were delivered by local community health volunteers (CHVs) over 8 months. We estimate the opportunity costs for the CHVs and participants in our program under both delivery models and predict the future benefits and costs stemming from participation, such as increases in lifetime wages and schooling costs. We find that children experienced large improvements in their cognitive development at very reasonable costs under both delivery models, but the group-only model was the most cost-effective. Under reasonable assumptions about the future, we find that long-term program benefits could outweigh its associated costs by a factor of 15, implying a large potential return on investment (ROI) for a government willing to scale this program. Our findings are very encouraging for the investment into ECD parenting programs for resource-poor and rural settings. As national and international policymakers increasingly encourage investment into ECD parenting programs, our results represent a strong case study for a promising means to do so.
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DOI：
10.1016/s0140-6736(16)31389-7
发表时间：
2017-01-07
期刊：
Lancet (London, England)
影响因子：
--
作者：
Black MM;Walker SP;Fernald LCH;Andersen CT;DiGirolamo AM;Lu C;McCoy DC;Fink G;Shawar YR;Shiffman J;Devercelli AE;Wodon QT;Vargas-Barón E;Grantham-McGregor S;Lancet Early Childhood Development Series Steering Committee
通讯作者：
Lancet Early Childhood Development Series Steering Committee
DOI：
10.1016/s2214-109x(20)30469-1
发表时间：
2021-03
期刊：
The Lancet. Global health
影响因子：
--
作者：
Luoto JE;Lopez Garcia I;Aboud FE;Singla DR;Fernald LCH;Pitchik HO;Saya UY;Otieno R;Alu E
通讯作者：
Alu E
DOI：
10.1111/nyas.12331
发表时间：
2014-01-01
期刊：
EVERY CHILD'S POTENTIAL: INTEGRATING NUTRITION AND EARLY CHILDHOOD DEVELOPMENT INTERVENTIONS
影响因子：
--
作者：
Alderman, Harold;Behrman, Jere R.;Urzua, Sergio
通讯作者：
Urzua, Sergio
DOI：
10.1111/nyas.12367
发表时间：
2014-01-01
期刊：
EVERY CHILD'S POTENTIAL: INTEGRATING NUTRITION AND EARLY CHILDHOOD DEVELOPMENT INTERVENTIONS
影响因子：
--
作者：
Gowani, Saima;Yousafzai, Aisha K.;Bhutta, Zulfiqar A.
通讯作者：
Bhutta, Zulfiqar A.
影响因子：
5.2
作者：
Luoto JE;Lopez Garcia I;Aboud FE;Singla DR;Zhu R;Otieno R;Alu E
通讯作者：
Alu E