Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial

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.

Patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa: a systematic review

“…This study aims to assess patient and health system costs associated with the management of pregnancy and birth-related complications in sub-Saharan Africa. The results will feed into a cost-benefit analysis study comparing two adolescent pregnancy prevention strategies in Zambia to help policymakers to choose the strategy with the greatest potential for return on investment [9]. The study findings may also be useful to researchers and policymakers elsewhere as it aims to provide cost evidence that can facilitate economic evaluation and budget impact analyses of maternal and child health interventions to demonstrate whether they represent value for money or not in addition to positive public health impact.…”

Intestinal prolapse and exposure after peritoneal dialysis in low-birth-weight preterm infants with acute renal failure: a case report

“…Compared with singleton newborns, twin newborns have a higher risk of perinatal death. Neonatal death occurs mainly in pregnant women at 34 weeks of gestation ( 8 ). Respiratory distress syndrome is a common complication for premature twin infants and a common cause of premature infant death ( 7 , 8 ).…”

“…Neonatal death occurs mainly in pregnant women at 34 weeks of gestation ( 8 ). Respiratory distress syndrome is a common complication for premature twin infants and a common cause of premature infant death ( 7 , 8 ). The incidence of premature membrane rupture in the mother is also higher in twin pregnancies than in singleton pregnancies ( 9 ).…”

Factors Affecting Nonmarital Pregnancy in Teenagers at Soe City Public Health Center Work Area, Soe City Sud-District, South Mid-East Regency

“…Early marriage, pregnancy and childbirth are the leading causes of school dropout among young people in Africa (Mori,et al, 2017). Globally, about 16 million girls aged 15-19, and 1 million younger than 15 years, give birth each year.…”