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Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial

Published in: Trials | Issue 1/2017

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Abstract

Background

Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living.

Methods

The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives.

Discussion

While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be considered seriously when evaluating whether such a program can justify the required investments in a setting with scarce resources. The economic evaluations outlined in this paper will generate valuable information that can be used to guide large-scale implementation of programs to address the problem of the high prevalence of adolescent childbirth and school drop-outs in similar settings.

Trial registration

ClinicalTrials.gov, NCT02709967. Registered on 2 March 2016. ISRCTN, ISRCTN12727868. Registered on 4 March 2016.
Literature
1.
WHO. Adolescent pregnancy: Fact sheet No 364. Geneva: World Health Organization; 2014.
2.
Jain S, Kurz K. New insights on preventing child marriage: global analysis of factors and programs. Washngton DC: International Center for Research on Women; 2007.
3.
Mokdad AH, Forouzanfar MH, Daoud F, Mokdad AA, El Bcheraoui C, Moradi-Lakeh M, Kyu HH, Barber RM, Wagner J, Cercy K, et al. Global burden of diseases, injuries, and risk factors for young people’s health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10036):2383–401.CrossRefPubMed
4.
Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med. 1995;332(17):1113–7.CrossRefPubMed
5.
Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36(2):368–73.CrossRefPubMed
6.
Weldearegawi B, Melaku YA, Abera SF, Ashebir Y, Haile F, Mulugeta A, Eshetu F, Spigt M. Infant mortality and causes of infant deaths in rural Ethiopia: a population-based cohort of 3684 births. BMC Public Health. 2015;15:770.CrossRefPubMedPubMedCentral
7.
Althabe F, Moore JL, Gibbons L, Berrueta M, Goudar SS, Chomba E, Derman RJ, Patel A, Saleem S, Pasha O, et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: the Global Network’s Maternal Newborn Health Registry study. Reprod Health. 2015;12 Suppl 2:S8.CrossRefPubMedPubMedCentral
8.
Lloyd CB, Mensch BS. Marriage and childbirth as factors in dropping out from school: an analysis of DHS data from sub-Saharan Africa. Popul Stud. 2008;62(1):1–13.CrossRef
9.
Gordon B. Out of wedlock, into school: combating child marriage through education. London: Office of Sarah and Gordon Brown; 2012.
10.
Rosenberg M, Pettifor A, Miller WC, Thirumurthy H, Emch M, Afolabi SA, Kahn K, Collinson M, Tollman S. Relationship between school dropout and teen pregnancy among rural South African young women. Int J Epidemiol. 2015;44(3):928–36.CrossRefPubMedPubMedCentral
11.
Central Statistical Office, Ministry of Health, ICF Macro International. Zambia Demographic and Health Survey, 2013–14. Rockville; 2014.
12.
Ministry of Education, Science, Vocational Training and Early Education (MESVTEE). Education for All 2015 National Review Report. Zambia; 2015
13.
Moore AM, Biddlecom AE, Zulu EM. Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Afr J Reprod Health. 2007;11(3):44–61.CrossRefPubMedPubMedCentral
14.
Psacharopoulos G, Patrinos H. Returns to investment in education: a further update. Educ Econ. 2004;12(2):111–34.CrossRef
15.
McQueston K, Silverman R, Glassman A. The efficacy of interventions to reduce adolescent childbearing in low- and middle-income countries: a systematic review. Stud Fam Plann. 2013;44(4):369–88.CrossRefPubMed
16.
Goesling B, Colman S, Trenholm C, Terzian M, Moore K. Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: a systematic review. J Adolesc Health. 2014;54(5):499–507.CrossRefPubMed
17.
Rosenthal MS, Ross JS, Bilodeau R, Richter RS, Palley JE, Bradley EH. Economic evaluation of a comprehensive teenage pregnancy prevention program: pilot program. Am J Prev Med. 2009;37(6 Suppl 1):S280–7.CrossRefPubMedPubMedCentral
18.
Wang LY, Davis M, Robin L, Collins J, Coyle K, Baumler E. Economic evaluation of Safer Choices: a school-based human immunodeficiency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med. 2000;154(10):1017–24.CrossRefPubMed
19.
20.
Perkins M, Brazier E, Themmen E, Bassane B, Diallo D, Mutunga A, Mwakajonga T, Ngobola O. Out-of-pocket costs for facility-based maternity care in three African countries. Health Policy Plan. 2009;24(4):289–300.CrossRefPubMedPubMedCentral
21.
Kruk ME, Mbaruku G, Rockers PC, Galea S. User fee exemptions are not enough: out-of-pocket payments for ‘free’ delivery services in rural Tanzania. Trop Med Int Health. 2008;13(12):1442–51.CrossRefPubMed
22.
Masiye F, Kaonga O, Kirigia JM. Does user fee removal policy provide financial protection from catastrophic health care payments? Evidence from Zambia. PLoS One. 2016;11(1), e0146508.CrossRefPubMedPubMedCentral
23.
Sandoy IF, Mudenda M, Zulu J, Munsaka E, Blystad A, Makasa MC, Maestad O, Tungodden B, Jacobs C, Kampata L, et al. Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial. Trial. 2016;17(1):588.CrossRef
24.
Directorate of Planning and Education. Educational Statistical Bulletin 2014, vol. 14. Lusaka: Ministry of General Education; 2016
25.
Nkosha C, El-Bashir H. Global initiative to support out of school children in Zambia. Lusaka: Ministry of Education, Science, Vocational Training and Early Education and UNICEF; 2014.
26.
Mincer J. Schooling, experience and earnings. New York: National Bureau of Economic Research, Columbia University Press; 1974.
27.
Mphuka C, Simumba J. Estimating returns to education in Zambia. Lusaka: Zambia Institute for Policy Analysis and Research; 2013.
28.
Central Statistical Office. Living conditions monitoring survey report 2006 and 2010. Lusaka; 2011
29.
Chaaban J. The costs of youth exclusion in the Middle East. Middle East Youth Initiative Working Paper No. 7; 2008.
30.
Chaaban J, Cunningham W. Measuring the economic gain of investing in girls-the girl effect dividend. Policy Research Working Paper No. 5753; 2011.
31.
Ngalesoni F, Ruhago G, Norheim OF, Robberstad B. Economic cost of primary prevention of cardiovascular diseases in Tanzania. Health Policy Plan. 2015;30(7):875–84.CrossRefPubMed
32.
Wagstaff A, van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ. 2003;12(11):921–34.CrossRefPubMed
33.
Xu K, Evans D, Carrin G, Rivera A, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007;26(4):972–83.CrossRef
34.
Grosh M, Glewwe P. Designing household survey for developing countries: lessons from 15 years of the Living Standards Measurement Study. Washington, D.C; World Bank; 2000.
35.
Glick HA. Sample size and power for cost-effectiveness analysis (part 1). Pharmacoeconomics. 2011;29(3):189–98.CrossRefPubMed
36.
Briggs AH, Gray AM. Power and sample size calculations for stochastic cost-effectiveness analysis. Med Decis Making. 1998;18(2 Suppl):S81–92.CrossRefPubMed
37.
Gafni A, Walter SD, Birch S, Sendi P. An opportunity cost approach to sample size calculation in cost-effectiveness analysis. Health Econ. 2008;17(1):99–107.CrossRefPubMed
38.
39.
Boardman AE, Greenberg DH, Vining AR, Weimer DL. Cost-benefit analysis: concepts and practice. 4th ed. London: Prentice Hall; 2014.
40.
Gomes M, Ng ES, Grieve R, Nixon R, Carpenter J, Thompson SG. Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med Decis Making. 2012;32(2):350–61.CrossRefPubMedPubMedCentral
41.
Bachmann MO, Fairall L, Clark A, Mugford M. Methods for analyzing cost effectiveness data from cluster randomized trials. Cost Eff Resour Alloc. 2007;5:12.CrossRefPubMedPubMedCentral
42.
Xu K. Distribution of payments and catastrophic expenditures methodogy. Geneva: World Health Organization; 2005.
43.
Sicuri E, Bardaji A, Sigauque B, Maixenchs M, Nhacolo A, Nhalungo D, Macete E, Alonso PL, Menendez C. Costs associated with low birth weight in a rural area of Southern Mozambique. PLoS One. 2011;6(12), e28744.CrossRefPubMedPubMedCentral
44.
Petrou S, Sach T, Davidson L. The long-term costs of preterm birth and low birth weight: results of a systematic review. Child Care Health Dev. 2001;27(2):97–115.CrossRefPubMed
45.
Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, Dias T, Potetz L, Davidoff MJ, Damus K, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120(1):e1–9.CrossRefPubMed
46.
Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007;27(10):614–9.CrossRefPubMed
47.
Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, Stein AD, Sinha S, Tandon N, Adair L, et al. Association between maternal age at childbirth and child and adult outcomes in the off spring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health. 2015;3:e366–77.CrossRefPubMed
48.
SCAA. Teenage births: outcomes for young parents and their children. New York: Schuyler Center for Analysis and Advocacy; 2008.
49.
Schäferhoff M, Evans D, Burnett N, Komaromi P, Kraus J, Levin A, Obure CD, Pradhan E, Sutherland CS, Suzuki E, et al. Estimating the costs and benefits of education from a health perspective. Berlin: SEEK Development – Strategic and Organizational Consultants GmbH; 2014.
50.
Kelman S. Cost-benefit analysis: an ethical critique. Regulation. 1981;5(1):33–40.PubMed
51.
Messonier M, Meltzer M. Cost-Benefit Analysis. In: Haddix AC, Teutsch SM, Corso PS, editors. Prevention effectiveness-a guide to decision analysis and economic evaluation. New York: Oxford University Press, Inc; 2003. p. 127–54.
Metadata
Title
Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial
Publication date
01-12-2017
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2350-4

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