Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar

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• 作者：David Bishai (1)
  Karampreet Sachathep (1)
  Amnesty LeFevre (2)
  Hnin New Nwe Thant (3)
  Min Zaw (3)
  Tin Aung (3)
  Willi McFarland (4)
  Dominic Montagu (4)
  Social Franchising Research Team
  
  1. Department of Population Family and Reproductive Health ; Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe Street ; Baltimore ; MD ; 21205 ; USA
  2. Department of International Health ; Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe Street ; Baltimore ; MD ; 21205 ; USA
  3. PSI-Myanmar ; 16 West Shwe Gone Dine 4th Street ; Bahan Township ; Yangon ; Myanmar
  4. Department of Epidemiology ; University of California San Francisco ; San Francisco ; CA ; USA
  
• 关键词：Costing ; Zinc ; Oral rehydration ; Private providers ; Social franchise ; Myanmar ; Burma ; Cluster randomized trial
• 刊名：Cost Effectiveness and Resource Allocation
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 全文大小：1,144 KB
• 参考文献：1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151鈥?1. CrossRef
  2. Ministry of National Planning and Economic Development and UNICEF. Situation Analysis of Children in Myanmar. Nay Pyi Taw: UNICEF; 2012.
  3. Aung T, McFarland W, Khin HS, Montagu D. Incidence of pediatric diarrhea and public-private preferences for treatment in rural Myanmar: a randomized cluster survey. J Trop Pediatr. 2013;59:10鈥?. CrossRef
  4. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381:1405鈥?6. CrossRef
  5. Baqui AH, Black RE, El Arifeen S, Yunus M, Chakraborty J, Ahmed S, et al. Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial. BMJ. 2002;325:1059. CrossRef
  6. Bhandari N, Mazumder S, Taneja S, Dube B, Agarwal RC, Mahalanabis D, et al. Effectiveness of zinc supplementation plus oral rehydration salts compared with oral rehydration salts alone as a treatment for acute diarrhea in a primary care setting: a cluster randomized trial. Pediatrics. 2008;121:e1279-85. doi: 10.1542/peds.2007-1939 pmid: 18450870. CrossRef
  7. Aung T, McFarland W, Montagu D, Khin HSS, Schlein K, Hetherington J. Public-private preferences for treatment of pediatric illnesses among rural households of Myanmar. In: Proceedings of the Eighth World Congress on Health Economics. Toronto, Canada: International Health Economics Association; 2011.
  8. Bishai D, LeFevre A, Theuss M, Boxshall M, Hetherington JD, Zaw M, et al. The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar. Cost Effectiveness and Resource Allocation. 2013;11:14. C/E. CrossRef
  9. Christa W, Olivier F, Young MW, Black RE. Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ. 2009;87:780鈥?. doi: 10.2471/BLT.08.058990. CrossRef
  10. UN United Nations, Department of Economic and Social Affairs, Population Division. The 2010 Revision, Volume I: Comprehensive Tables ST/ESA/SER.A/313. 2011.
  11. Aung T, Montagu D, Su Su Khin H, Win Z, San AK, McFarland W, et al. The impact of a social franchising program on uptake of oral rehydration solution plus zinc for the treatment of childhood diarrhea in rural Myanmar: Results of a community-level cluster randomized trial. J Trop Peds. 2014;60:189鈥?7. CrossRef
  12. LiST. The Lives Saved Tool. Institute for International Programs, Johns Hopkins Bloomberg School of Public Health / . Retrieved May 12, 2013, from http://livessavedtool.org/.
  13. United Nations Statistics Division. Myanmar. World Statistics Pocketbook 2011. 2012. http://data.un.org/CountryProfile.aspx?crName=MYANMAR
  14. Macroeconomics and health. investing in health for economic development. Geneva: World Health Organization; 2001. p. 200.
  15. WHO. Estimating Costs for Cost-Effectiveness Analysis: Guidelines for Managers of Diarrhoeal Diseases Control Programmes. In: Estimating Costs for Cost-Effectiveness Analysis: Guidelines for Managers of Diarrhoeal Diseases Control Programmes. Geneva: Programme for Control of Diarrhoeal Diseases, WHO; 1988.
  16. WHO. Life Expectancy: Life Expectancy by Country: Myanmar. Global Health Observatory Data Repository. 2009. http://www.who.int/whr/2004/annex/country/mmr/en/
  17. Robberstad B, Strand T, Black RE, Sommerfelt H. Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries. Bull World Health Organ. 2004;82:523鈥?1.
  
• 刊物主题：Health Administration; Social Policy; Quality of Life Research;
• 出版者：BioMed Central
• ISSN：1478-7547

文摘

Introduction This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. Background The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Methods Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods. Findings Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted. Interpretation Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.