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Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya

BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Ken...

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Autores principales: Brown, Lecia, Martin, Alan, Were, Christopher, Biswas, Nandita, Liakos, Alexander, DeAngelis, Elena, Evitt, Lee Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8603569/
https://www.ncbi.nlm.nih.gov/pubmed/34794442
http://dx.doi.org/10.1186/s12913-021-06971-7
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author Brown, Lecia
Martin, Alan
Were, Christopher
Biswas, Nandita
Liakos, Alexander
DeAngelis, Elena
Evitt, Lee Alexandra
author_facet Brown, Lecia
Martin, Alan
Were, Christopher
Biswas, Nandita
Liakos, Alexander
DeAngelis, Elena
Evitt, Lee Alexandra
author_sort Brown, Lecia
collection PubMed
description BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06971-7.
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spelling pubmed-86035692021-11-19 Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya Brown, Lecia Martin, Alan Were, Christopher Biswas, Nandita Liakos, Alexander DeAngelis, Elena Evitt, Lee Alexandra BMC Health Serv Res Research BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06971-7. BioMed Central 2021-11-19 /pmc/articles/PMC8603569/ /pubmed/34794442 http://dx.doi.org/10.1186/s12913-021-06971-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Brown, Lecia
Martin, Alan
Were, Christopher
Biswas, Nandita
Liakos, Alexander
DeAngelis, Elena
Evitt, Lee Alexandra
Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_full Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_fullStr Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_full_unstemmed Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_short Cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in Kenya
title_sort cost and consequences of using 7.1 % chlorhexidine gel for newborn umbilical cord care in kenya
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8603569/
https://www.ncbi.nlm.nih.gov/pubmed/34794442
http://dx.doi.org/10.1186/s12913-021-06971-7
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