Management of Chest Indrawing Pneumonia in Children Under Five Years at the Outpatient Health Facilities in Nigeria: An Economic Evaluation

• Published in: Applied health economics and health policy 2021-05, Vol.19 (3), p.429-437
• Main Author: Okafor, Charles E.
• Format: Article
• Language: English
• Subjects: Antibiotics; Children; Clinical trials; Cost analysis; Cost benefit analysis; Developing countries; Effectiveness; Health Administration; Health care; Health care access; Health care industry; Health Economics; Health facilities; Health insurance; Health services; HIV; Human immunodeficiency virus; Insurance coverage; LDCs; Management; Management decisions; Medicine; Medicine & Public Health; Mortality; Oral administration; Original Research Article; Patient safety; Pharmacoeconomics and Health Outcomes; Pneumonia; Population; Public Health; Quality of Life Research
• ISSN: 1175-5652; 1179-1896
• DOI: 10.1007/s40258-020-00627-z

Background The recommendation of the World Health Organization (WHO) for the management of children aged < 5 years with chest indrawing pneumonia with oral amoxicillin dispersible tablets (DT) at the outpatient health facilities is imperative, especially in a high pneumonia mortality and low-resource setting like Nigeria. However, this recommendation has not been widely adopted in Nigeria due to poor access to healthcare and sub-optimal outpatient management and follow-up system to ensure patients’ safety and management effectiveness. This study aimed to evaluate the cost effectiveness and the cost benefit of the WHO recommendation relative to usual practices in Nigeria. The outcome of this study will provide supporting evidence to healthcare providers and inform their management decisions. Methods A cost-effectiveness and cost-benefit analyses of this study used a Markov cohort model from the healthcare provider perspective for a time horizon of five years. Three approaches were compared: a conventional approach (base-comparator); the amoxicillin DT (WHO) approach; and a parenteral approach. Bottom-up costing method was used. Health outcome was expressed as disability-adjusted life years averted and converted to monetary terms (benefit). Results The incremental cost-effectiveness ratio (ICER) and the benefit-cost ratio (BCR) of the amoxicillin DT approach dominate the conventional approach. The parenteral approach was more effective and more beneficial than the amoxicillin DT approach but the ICER and BCR were $75,655/DALY averted and 0.035, respectively. Conclusions The use of amoxicillin DT proves to be the optimal choice with high benefit and low cost. The opportunity cost of not adopting an approach more effective than amoxicillin DT will be offset by the cost saved. Its use in chest indrawing pneumonia management needs to be scaled up.