1. Improving the Quality of Care of Sick Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis Barasa W. E, Ayieko P, Cleary S, English M

2. Background Under 5 mortality continues to be a challenge globally In Kenya the under 5 mortality rate needs to reduce by 50% to meet the MDG 4 target The district hospital is an important avenue for delivering cost-effective child health interventions The quality of care in these hospitals has however been found to be poor in Kenya A multifaceted intervention to improve inpatient care in these hospital was tested and found to be effective. We present here a cost effectiveness analysis of the intervention

3. The Intervention

4. Objectives and Methods Objectives To determine the total economic costs of delivering ETAT+ To assess the cost effectiveness of the intervention To model the costs of scale up of ETAT+ to a national level Methods A cost-effectiveness analysis (CEA) alongside a cRCT Provider perspective Horizon – 18 months (Sep 2006 – Apr 2008) One way sensitivity analysis conducted on development & hotel costs, effectiveness and salaries

5. Methods Sample sizes Process of care: 1158 & 1157 at 18 months in intervention and control hospitals respectively Resource use: 6199 & 5115 in intervention and control hospitals respectively Measuring costs An ingredients approach Costs of developing, implementing and treatment where evaluated Measuring effectiveness Quality of care measured using process of care that span assessment, diagnosis and treatment

6. Assessing Costs-Effectiveness Intervention study not designed to measure mortality as a primary outcome The ICER was defined as the incremental cost per % improvement in QoC We also assessed likely cost per DALY averted estimates assuming plausible relative reductions in baseline inpatient mortality rate (7%) of between 1% and 10% This corresponds to absolute reductions in mortality of between 0.07% and 0.7%

7. Results: Intervention Costs Summary

8. Results: Incremental Cost-Effectiveness Ratio The additional cost per 1 percentage improvement in quality of care (ICER) was US$ 0.78 per child admission

9. Results: Estimated Costs of Scale-up Total costs of scale-up are US$ 3,633,123.45

10. Results: “What-If” Analysis

11. ICERs of other Key Child health Interventions

12. Discussions: Should ETAT+ be scaled up? There is therefore a strong case to scale up ETAT+ amongst other MNCH interventions