The cost-effectiveness of community health workers delivering free diarrhoea treatment: evidence from Uganda.
The cost-effectiveness of community health workers delivering free diarrhoea treatment: evidence from Uganda.
复制标题
社区卫生工作者提供免费腹泻治疗的成本效益：来自乌干达的证据。
DOI：
10.1093/heapol/czab120
复制
发表时间：
2022
影响因子：
3.2
通讯作者：
Levine,David
中科院分区：
文献类型：
--
作者：
Wagner,Zachary;Zutshi,Rushil;Asiimwe,JohnBosco;Levine,David
社区卫生工作者是乌干达和许多其他中低收入国家卫生基础设施的重要组成部分。虽然对卫生保健服务的需求是显而易见的，但不太清楚他们应该如何分发保健产品，以最大限度地提高其社区的健康效益。在这项研究中，我们评估了几种相互竞争的CHW分配策略在儿童腹泻治疗方面的成本效益。我们使用一项四臂整群随机对照试验的数据来评估(1)在腹泻发作前通过送货上门免费分发口服补液盐(ORS)(免费递送臂)、(2)通过代金券免费分发(家庭从中心位置检索治疗)(代金券臂)、(3)上门销售模式(房屋销售臂)和(4)控制臂(CHW照常开展活动)的成本效益。我们从实施者的角度和社会的角度评估了成本效益，即ORS治疗的每个病例的成本和避免的每个残疾调整生命年(DALY)的成本。从社会角度来看，免费送货是最有效、最便宜的战略。虽然这一部门的实施者成本最高，但成本节省来自于家庭使用较少的资源在家外寻求治疗(交通费、医疗费和治疗费)。从实施者的角度来看，与对照相比，免费递送每治疗一个额外病例的成本为2.19美元，避免一个DALY病例的成本为56美元。与房屋销售和代金券相比，免费送货也非常划算，但与代金券的比较存在很大程度的不确定性。与其他CHW分发模式相比，在腹泻发作前由CHW免费分发口服避孕药是非常划算的。社区妇女方案的实施者应考虑免费送货上门。
Community health workers (CHWs) are a vital part of the health infrastructure in Uganda and in many other low- and middle-income countries. While the need for CHWs is clear, it is less clear how they should dispense health products to maximize the health benefits to their community. In this study, we assess the cost-effectiveness of several competing CHW distribution strategies in the context of treatment for child diarrhoea. We used data from a four-armed cluster-randomized controlled trial to assess the cost-effectiveness of (1) free distribution of oral rehydration salts (ORS) via home deliveries prior to diarrhoea onset (free delivery arm), (2) free distribution via vouchers where households retrieved the treatment from a central location (voucher arm), (3) a door-to-door sales model (home sales arm) and (4) a control arm where CHWs carried out their activities as normal. We assessed the cost-effectiveness from the implementor’s perspective and a societal perspective in terms of cost per case treated with ORS and cost per disability-adjusted life year (DALY) averted. Free delivery was the most effective strategy and the cheapest from a societal perspective. Although implementor costs were highest in this arm, cost savings comes from households using fewer resources to seek treatment outside the home (transport, doctor fees and treatment costs). From the implementors’ perspective, free delivery costs $2.19 per additional case treated and $56 per DALY averted relative to the control. Free delivery was also extremely cost-effective relative to home sales and vouchers, but there was a large degree of uncertainty around the comparison with vouchers. Free distribution of ORS by CHWs prior to diarrhoea onset is extremely cost-effective compared to other CHW distribution models. Implementers of CHW programmes should consider free home delivery of ORS.