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Steve Hodgins MCHIP/ JSI (presenting), Amada Pomeroy MCHIP/ JSI, Hiwot Belay MCHIP/ JSI,

Pre-Eclampsia/ Eclampsia Interventions and their Cost Effectiveness Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21–25 February 2011. Steve Hodgins MCHIP/ JSI (presenting), Amada Pomeroy MCHIP/ JSI, Hiwot Belay MCHIP/ JSI, Marge Koblinsky MCHIP/ JSI.

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Steve Hodgins MCHIP/ JSI (presenting), Amada Pomeroy MCHIP/ JSI, Hiwot Belay MCHIP/ JSI,

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  1. Pre-Eclampsia/ Eclampsia Interventions and their Cost EffectivenessInterventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21–25 February 2011 Steve Hodgins MCHIP/ JSI (presenting), Amada Pomeroy MCHIP/ JSI, Hiwot Belay MCHIP/ JSI, Marge Koblinsky MCHIP/ JSI

  2. Planning and Prioritizing • In making decisions about supporting new initiatives, we select among options based on relative: • disease burden, • effectiveness of the proposed intervention(s), • feasibility and cost. • PE/E accounts for ~19% of maternal deaths in Africa • MgSO4 for treatment and calcium and ASA for prevention are known to be effective • For all 3 of these, the first two conditions are met • What about feasibility and cost?

  3. Feasibility • Feasibility – could we do this effectively in our setting? • Challenges for service providers, for the system • Cost – scalability, sustainability • Available service delivery platforms: ANC, HF deliveries, community-based distribution • MgSO4 issues • Antenatal ASA and calcium issues

  4. Interventions considered in our modeling • For pre-eclampsia/ eclampsia: • Prevention • antenatal calcium from 20 weeks • aspirin from 15 weeks • Treatment: MgSO4 loading dose • For comparison, we include: • Antenatal iron-folate from 20 weeks • Routine oxytocin during the 3rd stage, to prevent post-partum hemorrhage

  5. Intervention Efficacy • We don’t have as much evidence as we would like: difficulties for preventive intervention effects on maternal mortality. • Studies with huge samples are required to show mortality effects with adequate statistical power. • For established interventions, often it is considered unethical to do a RCT, as they would entail withholding such interventions. • In some cases, we have only proxy endpoints, e.g. serious morbidity, from which we infer comparable mortality effects, e.g. severe PE or severe PPH.

  6. Mortality Reduction Efficacy

  7. Effectiveness • As a common yardstick comparing preventive & treatment interventions, we are using averted maternal and neonatal deaths per 100,000 pregnancies/ deliveries reached • Depending on evidence available, we use efficacy in reducing cause-specific mortality or overall maternal or neonatal mortality

  8. Measuring Effectiveness • To model mortality reduction efficacy for calcium we multiply • MMR x %PE/E x documented efficacy. • So, in a country with an MMR of 500, • the number of averted deaths/ 100,000 reached = • 500 x 19% x .20 = 19 deaths

  9. Measuring Effectiveness • In the following 2 tables, we assume: • MMR = 500 • NNMR = 30 • PPH % of MMR = 34%* • PE/E % of MMR = 19%* • Prematurity % of NNMR = 29%* • * from Countdown Coverage 2010 report

  10. Averted deaths/ 100,000 reached

  11. Costs • Full costs vs. marginal costs; costs for whom • Up-front costs: training, infrastructure, equipment • Recurrent costs • Commodity-related: procurement, storage, transport, wastage • Supervision, maintenance and repair, some ongoing training • For interventions considered in this exercise, relatively modest up-front and non-commodity costs.

  12. Costs in this Modeling Exercise • For simplicity in comparing across interventions, cost assessment for this presentation has been restricted to commodity-related, reckoned /100,000 reached • Quantification: • Universal preventive vs. case-management for complications • Volume/ quantity required per patient/ beneficiary • Unit costs – costs per pill/ vial; from MSH price guide http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=Dmp&language=English

  13. Measuring Costs

  14. Conclusions & Next Steps • In deciding on new initiatives, consider: disease burden, effectiveness of interventions, feasibility, cost • We are finalizing a more complete analysis which we expect to make available shortly; this is intended as an aid to decision makers, particularly in ministries of health and among partner agencies

  15. For further information, you can contact me at: shodgins@mchip.net wwww.mchip.net Follow us on:

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