Skip to main content

Economic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol.

TitleEconomic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol.
Publication TypeJournal Article
Year of Publication2015
AuthorsKhowaja, A, Mitton, C, Bryan, S, Magee, LA, Bhutta, ZA, von Dadelszen, P
JournalImplement Sci
Volume10
Pagination76
Date Published2015 May 26
ISSN1748-5908
KeywordsAfrica, Asia, CLIP, Community Health Services, Community Participation, Cost-Benefit Analysis, Cross-Sectional Studies, Developing Countries, Female, Health Services, Humans, Infant, Male, Maternal-Child Health Services, Morbidity, Mortality, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Research Design, Residence Characteristics, Rural Health Services, World Health Organization
Abstract

BACKGROUND: Globally, hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, are the leading cause of maternal and neonatal mortality, and impose substantial burdens on the families of pregnant women, their communities, and healthcare systems. The Community Level Interventions for Pre-eclampsia (CLIP) Trial evaluates a package of care applied at both community and primary health centres to reduce maternal and perinatal disabilities and deaths resulting from the failure to identify and manage pre-eclampsia at the community level. Economic evaluation of health interventions can play a pivotal role in priority setting and inform policy decisions for scale-up. At present, there is a paucity of published literature on the methodology of economic evaluation of large, multi-country, community-based interventions in the area of maternal and perinatal health. This study protocol describes the application of methodology for economic evaluation of the CLIP in South Asia and Africa.

METHODS: A mixed-design approach i.e. cost-effectiveness analysis (CEA) and qualitative thematic analysis will be used alongside the trial to prospectively evaluate the economic impact of CLIP from a societal perspective. Data on health resource utilization, costs, and pregnancy outcomes will be collected through structured questionnaires embedded into the pregnancy surveillance, cross-sectional survey and budgetary reviews. Qualitative data will be collected through focus groups (FGs) with pregnant women, household male-decision makers, care providers, and district level health decision makers. The incremental cost-effectiveness ratio will be calculated for healthcare system and societal perspectives, taking into account the country-specific model inputs (costs and outcome) from the CLIP Trial. Emerging themes from FGs will inform the design of the model, and help to interpret findings of the CEA.

DISCUSSION: The World Health Organization (WHO) strongly recommends cost-effective interventions as a key aspect of achieving Millennium Development Goal (MDG)-5 (i.e. 75 % reduction in maternal mortality from 1990 levels by 2015). To date, most cost-effectiveness studies in this field have focused specifically on the diagnostic and clinical management of pre-eclampsia, yet rarely on community-based interventions in low-and-middle-income countries (LMICs). This study protocol will be of interest to public health scientists and health economists undertaking community-based trials in the area of maternal and perinatal health, particularly in LMICs.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT01911494.

DOI10.1186/s13012-015-0266-5
Alternate JournalImplement Sci
Citation Key544
PubMed ID26007682
PubMed Central IDPMC4446068