Forecasting burden of long-term disability from neonatal conditions: results from the Projahnmo I trial, Sylhet, Bangladesh

Health Policy Plan. 2013 Jul;28(4):435-52. doi: 10.1093/heapol/czs075. Epub 2012 Sep 23.

Abstract

Introduction: The burden of disease resulting from neonatal conditions is substantial in developing countries. From 2003 to 2005, the Projahnmo I programme delivered community-based interventions for maternal and newborn health in Sylhet, Bangladesh. This analysis quantifies burden of disability and incorporates non-fatal outcomes into cost-effectiveness analysis of interventions delivered in the Projahnmo I programme.

Methods: A decision tree model was created to predict disability resulting from preterm birth, neonatal meningitis and intrapartum-related hypoxia ('birth asphyxia'). Outcomes were defined as the years lost to disability (YLD) component of disability-adjusted life years (DALYs). Calculations were based on data from the Projahnmo I trial, supplemented with values from published literature and expert opinion where data were absent.

Results: 195 YLD per 1000 neonates [95% confidence interval (CI): 157-241] were predicted in the main calculation, sensitive to different DALY assumptions, disability weights and alternative model structures. The Projahnmo I home care intervention may have averted 2.0 (1.3-2.8) YLD per 1000 neonates. Compared with calculations based on reductions in mortality alone, the cost-effectiveness ratio decreased by only 0.6% from $105.23 to $104.62 ($65.15-$266.60) when YLD were included, with 0.6% more DALYs averted [total 338/1000 (95% CI: 131-542)].

Discussion: A significant burden of disability results from neonatal conditions in Sylhet, Bangladesh. Adding YLD has very little impact on recommendations based on cost-effectiveness, even at the margin of programme adoption. This model provides guidance for collecting data on disabilities in new settings.

Keywords: Summary measures; burden of illness; cost-effectiveness; neonatal health; outcomes research; years lost to disability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bangladesh / epidemiology
  • Community Health Services* / economics
  • Confidence Intervals
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Decision Trees
  • Disabled Children*
  • Encephalitis / complications
  • Encephalitis / epidemiology
  • Female
  • Forecasting
  • Home Care Services
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Meningitis / complications
  • Meningitis / epidemiology
  • Outcome Assessment, Health Care
  • Time Factors