Abstract
IntroductionThis paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL.BackgroundThe objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices.MethodsCosting from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods.FindingsBased on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted.InterpretationInvesting in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-015-0030-3) contains supplementary material, which is available to authorized users.
Highlights
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising
In response to empirical evidence demonstrating the impact of therapeutic supplementation of zinc and oral rehydration salts (ORS) (ORS-Z) for the management of acute diarrhea on health outcomes, including mortality, UNICEF and WHO issued a joint statement in 2004 recommending a change in global guidelines for the management of acute diarrhea to include supplementation with 20 mg of disbursable zinc sulphate in addition to reduced osmolarity ORS
Health impact The ORASEL impact study produced a difference in difference estimate showing that ORS plus zinc use increased significantly in the intervention tracts from 6.1% (0.3%-12%) to 13.7% (7.3%-20.2%), as compared to slight statistically insignificant declines in ORS use in the comparison area (4.8% to 1.8%) over the same time period [11]
Summary
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Diarrheal diseases remain the second leading cause of death amongst children under 5, accounting for an estimated 0.75 million deaths globally [1]. Diarrhea is the second leading cause of child death in Myanmar, causing 13% of deaths of children under five [2]. Significant challenges remain in establishing systems for promoting high coverage especially in rural areas [4,5,6]
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