• Amnesty E LeFevre, Samuel D Shillcutt, Hugh R Waters, Sabbir Haider, Shams El Arifeen, Ishtiaq Mannan, Habibur R Seraji, Rasheduzzaman Shah, Gary L Darmstadt, Steve N Wall, Emma K Williams, Robert E Black, Mathuram Santosham, Abdullah H Baqui, and Projahnmo Study Group.
• Department of International Health, Johns Hopkins Bloomberg School of Public Health, Suite E-8139, 615 North Wolfe Street, Baltimore MD 21205, United States of America (USA).
• Bull. World Health Organ. 2013 Oct 1; 91 (10): 736-45.

ObjectiveTo evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh.MethodsIn a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy--compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis.FindingsThe incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, CI: 1833-7616) United States dollars (US$) per neonatal death averted and US$ 103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$ 104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective.ConclusionThe home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere.

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