Abstract
BackgroundEarly 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.MethodsThe 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.DiscussionWhile 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 registrationClinicalTrials.gov, NCT02709967. Registered on 2 March 2016. ISRCTN, ISRCTN12727868. Registered on 4 March 2016.
Highlights
Marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa
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
The interventions are being delivered by teachers and community health assistants (CHAs) or community health workers (CHWs)
Summary
A detailed description of the trial has been published elsewhere [23]. we provide here a brief summary, which we think is important for understanding the planned economic evaluations to be conducted alongside the trial. The Research Initiative to Support the Empowerment of Girls (RISE) study is a three-arm cluster randomized controlled trial (cRCT), which is currently being conducted in Zambia. Description of intervention packages The trial aims to compare the effectiveness of economic support with or without a corresponding community dialogue component, in reducing adolescent childbearing and in increasing grade 9 completion rates. The interventions were launched in September 2016 and will continue until November 2018, which is the time when the girls in the study are expected to complete grade 9 (Fig. 1). The interventions are being delivered by teachers and community health assistants (CHAs) or community health workers (CHWs). This will make the results realistic and relevant for any potential scale-up in Zambia or other similar contexts
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