Cost-effectiveness of an injury and drowning prevention program in Bangladesh

Pediatrics. 2012 Dec;130(6):e1621-8. doi: 10.1542/peds.2012-0757. Epub 2012 Nov 12.


Objective: Interventions that mitigate drowning risk in developing countries are needed. This study presents the cost-effectiveness of a low-cost, scalable injury and drowning prevention program called Prevention of Child Injuries through Social-Intervention and Education (PRECISE) in Bangladesh.

Methods: Between 2006 and 2010, the 2 components of PRECISE (Anchal, which sequestered children in crèches [n = 18 596 participants], and SwimSafe, which taught children how to swim [n = 79421 participants]) were implemented in rural Bangladesh. Mortality rates for participants were compared against a matched sample of nonparticipants in a retrospective cohort analysis. Effectiveness was calculated via Cox proportional hazard analysis. Cost-effectiveness was estimated according to World Health Organization-CHOosing Interventions that are Cost Effective guidelines.

Results: Anchal costs between $50.74 and $60.50 per child per year. SwimSafe costs $13.46 per child. For Anchal participants, the relative risk of a drowning death was 0.181 (P = .004). The relative risk of all-cause mortality was 0.56 (P = .001). For SwimSafe, the relative risk of a drowning death was 0.072 (P < .0001). The relative risk of all-cause mortality was 0.750 (P = .024). For Anchal, the cost per disability-adjusted life-year (DALY) averted is $812 (95% confidence interval: $589\x{2013}$1777). For SwimSafe, the cost per DALY averted is $85 ($51\x{2013}$561). Combined, the cost per DALY averted is $362 ($232\x{2013}$1364).

Conclusions: Based on World Health Organization criteria, PRECISE is very cost-effective and should be considered for implementation in other areas where drowning is a significant problem.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accident Prevention / economics*
  • Bangladesh
  • Cause of Death
  • Child
  • Child Day Care Centers
  • Child, Preschool
  • Cost-Benefit Analysis / economics
  • Cost-Benefit Analysis / statistics & numerical data
  • Developing Countries*
  • Drowning / mortality
  • Drowning / prevention & control*
  • Female
  • Humans
  • Infant
  • Male
  • Population Surveillance
  • Proportional Hazards Models
  • Risk
  • Rural Population
  • Swimming / education
  • Swimming / statistics & numerical data
  • Wounds and Injuries / mortality
  • Wounds and Injuries / prevention & control*