Cost-effectiveness assessment of the Inspire2Care program in Ilam FINAL REPORT 22 October 2018 Kelsey Vaughan, MSc, MPP Aradhana Thapa, MPH Rashmi Paudel, MPH Bang for Buck Consulting Tweede Schinkelstraat 7-1 1075TN Amsterdam Telephone +31 6 272 45970
[email protected] Table of Contents TABLE OF CONTENTS I TABLE OF TABLES III TABLE OF FIGURES IV ACRONYMS V EXECUTIVE SUMMARY 1 1 BACKGROUND 3 About Karuna’s Inspire2Care (I2C) program 3 Assessment 5 2 METHODOLOGY 7 Cost-effectiveness assessment 7 2.1.1 Overview 7 2.1.2 Assessment period 7 2.1.3 Measuring cost-effectiveness 7 2.1.3.1 Measuring total expenditure 8 2.1.3.2 Measuring effectiveness 9 2.1.3.3 Extrapolation of findings to non-sampled VDCs 14 2.1.3.4 Cost per DALY averted 14 2.1.3.5 Cost-effectiveness of replication 14 2.1.3.6 Limitations of cost-effectiveness analysis 14 2.1.4 Prevention evidence review 15 2.1.4.1 Literature review methodology 16 2.1.4.2 HMIS 17 2.1.4.3 Prevention of birth defects data 17 3 RESULTS AND DISCUSSION 18 Cost-effectiveness 18 3.1.1 Total expenditure 18 3.1.2 DALYs averted 19 3.1.3 Cost-effectiveness of I2C implementation to date 20 3.1.4 Cost-effectiveness of I2C batch 3 21 3.1.5 Cost-effectiveness of I2C scaling in Ilam district 21 i 3.1.6 Comparison of findings 22 3.1.6.1 Comparison with pilot 22 3.1.6.2 Comparison with other available evidence: Nepal and internationally 23 Prevention 24 3.2.1 Literature review 24 3.2.1.1 Search results 24 3.2.1.2 Interventions which prevent birth defects 25 3.2.2 HMIS 36 3.2.3 Birth defects 36 4 RECOMMENDATIONS