Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2017

Open Access 01-12-2017 | Research

Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework

Authors: Samuel D. Shillcutt, Amnesty E. LeFevre, Christa L. Fischer-Walker, Sunita Taneja, Robert E. Black, Sarmila Mazumder

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2017

Login to get access

Abstract

Background

This study evaluates the cost-effectiveness of the DAZT program for scaling up treatment of acute child diarrhea in Gujarat India using a net-benefit regression framework.

Methods

Costs were calculated from societal and caregivers’ perspectives and effectiveness was assessed in terms of coverage of zinc and both zinc and Oral Rehydration Salt. Regression models were tested in simple linear regression, with a specified set of covariates, and with a specified set of covariates and interaction terms using linear regression with endogenous treatment effects was used as the reference case.

Results

The DAZT program was cost-effective with over 95% certainty above $5.50 and $7.50 per appropriately treated child in the unadjusted and adjusted models respectively, with specifications including interaction terms being cost-effective with 85–97% certainty.

Discussion

Findings from this study should be combined with other evidence when considering decisions to scale up programs such as the DAZT program to promote the use of ORS and zinc to treat child diarrhea.
Appendix
Available only for authorised users
Literature
1.
Palmer S, Torgerson DJ. Economics notes: definitions of efficiency. Br Med J. 1999;318(7191):1136.CrossRef
2.
Sculpher M, et al. Whither trial-based economic evaluation for health care decision making? Health Econ. 2006;15:677–87.CrossRefPubMed
3.
Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 2002;11:415–30.CrossRefPubMed
4.
Tan-Torres Edejer T, et al. Cost effectiveness analysis of strategies for child health in developing countries. BMJ. 2005;331(7526):1177.CrossRef
5.
6.
7.
Jones AE, Troyer JL, Kline JA. Cost-effectiveness of an emergency department based early sepsis resuscitation protocol. Crit Care Med. 2011;39(6):1306.CrossRefPubMedPubMedCentral
8.
Hedden L, et al. Incremental cost-effectiveness of the pre-and post-bevacizumab eras of metastatic colorectal cancer therapy in British Columbia, Canada. Eur J Cancer. 2012;48(13):1969–76.CrossRefPubMed
9.
Borghi J, et al. Protocol for the evaluation of a pay for performance programme in Pwani region in Tanzania: a controlled before and after study. Implement Sci. 2013;8(1):1–12.CrossRef
10.
Shillcutt SD, et al. Protocol for the economic evaluation of the diarrhea alleviation through zinc and oral rehydration salt therapy at scale through private and public providers in rural Gujarat and Uttar Pradesh, India. Implement Sci. 2015;19:164.
11.
Shillcutt SD, et al. Economic costs to caregivers of diarrhea treatment among children under 5 in rural Gujarat India: findings from an uncontrolled before and after evaluation of the diarrhea alleviation through zinc and oral rehydration salts treatment program at scale. Health Policy Plan. 2016;31(10):1411–22.CrossRefPubMed
12.
Lamberti LM, et al. An external effectiveness evaluation of the diarrhea alleviation through Zinc and ORS treatment program in Gujarat and Uttar Pradesh, India. J Glob Health. 2015;5(2):020409.CrossRefPubMedPubMedCentral
13.
LeFevre AE, et al. Economic evaluation of a community-based newborn care intervention implemented through two service delivery strategies in Sylhet district, Bangladesh: a cluster randomized controlled trial. Bull WHO. 2013;91:736–45.PubMedPubMedCentral
14.
Lewycka S, et al. Effect of women’s groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial. Lancet. 2013;381(9879):1721–35.CrossRefPubMedPubMedCentral
15.
Walker CLF, et al. Appropriate management of acute diarrhea in children among public and private providers in Gujarat, India: a cross-sectional survey. Glob Health Sci Pract. 2015;3:230–41.CrossRefPubMedPubMedCentral
16.
Government of India, Census of India 2011. 2011, Ministry of Home Affairs, Office of the Registrar General and Census Commissioner: Yojana.
17.
DAZT. Baseline cross sectional survey-Internal report. Baltimore: Johns Hopkins University; 2011.
18.
DAZT. Enhancing the uptake of ORS and zinc in targeted areas of India, Midline cross sectional survey internal report. Baltimore: Johns Hopkins University; 2012.
19.
DAZT, Endline community household survey-Gujarat study protocol. Baltimore: Johns Hopkins University; 2013.
20.
Shillcutt SD, et al. Cost-effectiveness in low- and middle-income countries: a review of debates surrounding decision rules. Pharmacoeconomics. 2009;27(11):903–17.CrossRefPubMedPubMedCentral
21.
Glick HA. Sample size and power for cost-effectiveness analysis (Part 1). Pharmacoeconomics. 2011;29(3):189–98.CrossRefPubMed
22.
Bhandari N, Mazumder S, Taneja S, Dube B, Agarwal RC, Mahalanabis D, Fontaine O, Black RE, Bhan MK. 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(5):e1279–85.CrossRefPubMed
23.
Glick HA. Sample size and power for cost-effectiveness analysis (Part 2): the effect of maximum willingness to pay. Pharmacoeconomics. 2011;29(4):287–96.PubMed
24.
SNL. Saving newborn lives initiative: project costing guidelines. Washington DC: Save the Children; 2004.
25.
Drummond MF, et al. Methods for the economic evaluation of health care programs. 3rd ed. Oxford: Oxford University Press; 2005.
26.
Gold MR, et al. Cost effectiveness in health and medicine. New York: Oxford University Press; 1996.
27.
Edejer TT, et al., eds. WHO guide to cost-effectiveness analysis. Geneva: World Health Organisation; 2003.
28.
Kumaranayake L. The real and the nominal? Making inflationary adjustments to cost and other economic data. Health Policy Plan. 2000;15(2):230–4.CrossRefPubMed
29.
Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 1973: p. 95–124.
30.
Rheingans R, et al. Determinants of household costs associated with childhood diarrhea in 3 South Asian settings. Clin Infect Dis. 2012;55(suppl 4):S327–35.CrossRefPubMedPubMedCentral
31.
Nagler J. Notes on simultaneous equations and two stage least squares estimates. 1999.
32.
Dales LG, Ury HK. An improper use of statistical significance testing in studying covariables. Int J Epidemiol. 1978;7(4):373–6.CrossRefPubMed
33.
Greenland S, Neutra R. Control of confounding in the assessment of medical technology. Int J Epidemiol. 1980;9(4):361–7.CrossRefPubMed
34.
35.
36.
37.
Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36.CrossRefPubMed
38.
Filmer D, Pritchett LH. Estimating wealth effects without expenditure data-or tears: an application to educational enrolments in states of India. Demography. 2001;38:115–32.PubMed
39.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed
40.
Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;18(3):341–64.CrossRefPubMed
41.
Oxman AD, Guyatt GH. A consumer’s guide to subgroup analyses. Ann Intern Med. 1992;116(1):78–84.CrossRefPubMed
42.
Ramaekers BL, Joore MA, Grutters JP. How should we deal with patient heterogeneity in economic evaluation: a systematic review of national pharmacoeconomic guidelines. Value Health. 2013;16(5):855–62.CrossRefPubMed
43.
Sabot O, et al. Scaling up oral rehydration salts and zinc for the treatment of diarrhoea. BMJ. 2012;344:e940.CrossRefPubMed
44.
Jha P, Laxminarayan R. Choosing health: An entitlement for all Indians. Center for Global Health Research; 2009.
45.
Grutters JP, et al. Acknowledging patient heterogeneity in economic evaluation. Pharmacoeconomics. 2013;31(2):111–23.CrossRefPubMed
46.
Mazumder S, et al. Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state, India. Bull World Health Organ. 2010;88(10):754–60.CrossRefPubMedPubMedCentral
47.
48.
49.
Gupta SK, et al. Proposed pharmacoeconomics guidelines for India (PEG-I). New Delhi: International Society of Pharmacoeconomics and Outcomes Research India Chapter; 2013.
50.
Hounton S, Newlands D. Applying the net-benefit framework for assessing cost-effectiveness of interventions towards universal health coverage. Cost Eff Resour Alloc. 2012;10(1):8.CrossRefPubMedPubMedCentral
51.
Hounton S, Newlands D. Applying the net-benefit framework for analyzing and presenting cost-effectiveness analysis of a maternal and newborn health intervention. PLoS ONE. 2012;7(7):e40995.CrossRefPubMedPubMedCentral
52.
WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers. Geneva: World Health Organization; 2005. p. 1–50.
53.
Robberstad B, et al. Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries. Bull WHO. 2004;82(7):523–31.PubMedPubMedCentral
54.
Bishai D, et al. Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar. Cost Eff Res Alloc. 2015;13(1):3.CrossRef
55.
Patel AB, Badhoniya N, Dibley MJ. Zinc and copper supplementation are not cost-effective interventions in the treatment of acute diarrhea. J Clin Epidemiol. 2013;66(1):52–61.CrossRefPubMed
56.
Patel AB, Dhande LA, Rawat MS. Economic evaluation of zinc and copper use in treating acute diarrhea in children: a randomized control trial. Cost Eff Res Alloc. 2003;1(1):7.CrossRef
57.
Gregorio GV, et al. Zinc supplementation reduced cost and duration of acute diarrhea in children. J Clin Epidemiol. 2007;60(6):560–6.CrossRefPubMed
58.
59.
60.
USAID, Enhancing zinc use for diarrhoea management in India. Washington DC: United States Agency for International Development; 2011.
61.
Government of India, Policy on use of zinc in the national programme for management for diarrhoea. New Delhi; 2006.
62.
Million Death Study Collaborators. Causes of neonatal and child mortality in India: nationally representative mortality survey. Lancet. 2010;376(9755):1853.CrossRef
63.
UN, Levels & trends in child mortality: report 2011, estimates developed by the UN inter-agency group for child mortality estimation. Geneva: United Nations; 2011.
64.
UN, Levels & trends in child mortality: report 2013, estimates developed by the UN inter-agency group for child mortality estimation. Geneva: United Nations; 2013.
65.
Fischer-Walker CL, et al. Appropriate Management of Acute Diarrhea in Children Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey. Glob Health Sci Pract. 2015;3(2):230–41.CrossRef
66.
67.
Sreeramareddy CT, et al. Care seeking behaviour for childhood illness-a questionnaire survey in western Nepal. BMC Int Health Human Rights. 2006;6(1):7.CrossRef
68.
Taffa N, Chepngeno G. Determinants of health care seeking for childhood illnesses in Nairobi slums. Trop Med Int Health. 2005;10(3):240–5.CrossRefPubMed
69.
Sreeramareddy CT, Sathyanarayana T, Kumar HH. Utilization of health care services for childhood morbidity and associated factors in India: a national cross-sectional household survey. PLoS ONE. 2012;7(12):e51904.CrossRefPubMedPubMedCentral
70.
71.
Ahmed S, Sobhan F, Islam A. Neonatal morbidity and care-seeking behaviour in rural Bangladesh. J Trop Pediatrics. 2001;47(2):98–105.CrossRef
72.
Wooldridge JM. Introductory econometrics: a modern approach. 4th ed. Mason: South-Western Cenage Learning; 2009.
73.
Sanders GD, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103.CrossRefPubMed
Metadata
Title
Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework
Authors
Samuel D. Shillcutt
Amnesty E. LeFevre
Christa L. Fischer-Walker
Sunita Taneja
Robert E. Black
Sarmila Mazumder
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2017
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/s12962-017-0070-y

Other articles of this Issue 1/2017

Cost Effectiveness and Resource Allocation 1/2017 Go to the issue

Research

Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009–2012

Research

Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya

Review

Economic evaluations of vaccines in Canada: a scoping review

Research

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

Research

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Research

Cost effectiveness of vildagliptin versus glimepiride as add-on treatment to metformin for the treatment of diabetes mellitus type 2 patients in Greece