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Baek Y, Ademi Z, Tran T, Owen A, Nguyen T, Luchters S, Hipgrave DB, Hanieh S, Tran T, Tran H, Biggs BA, Fisher J. Promoting early childhood development in Viet Nam: cost-effectiveness analysis alongside a cluster-randomised trial. Lancet Glob Health 2023; 11:e1269-e1276. [PMID: 37474233 DOI: 10.1016/s2214-109x(23)00271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Economic evaluations are critical to ensure effective resource use to implement and scale up child development interventions. This study aimed to estimate the cost-effectiveness of a multicomponent early childhood development intervention in rural Viet Nam. METHODS We did a cost-effectiveness study alongside a cluster-randomised trial with a 30-month time horizon. The study included 669 mothers from 42 communes in the intervention group, and 576 mothers from 42 communes in the control group. Mothers in the intervention group attended Learning Clubs sessions from mid-pregnancy to 12 months after delivery. The primary outcomes were child cognitive, language, motor, and social-emotional development at age 2 years. In this analysis, we estimated the incremental cost-effectiveness ratios (ICERs) of the intervention compared with the usual standard of care from the service provider and household perspectives. We used non-parametric bootstrapping to examine uncertainty, and applied a 3% discount rate. FINDINGS The total intervention cost was US$169 898 (start-up cost $133 692 and recurrent cost $36 206). The recurrent cost per child was $58 (1 341 741 Vietnamese dong). Considering the recurrent cost alone, the base-case ICER was $14 and mean ICER of 1000 bootstrap samples was $14 (95% CI -0·48 to 30) per cognitive development score gained with a 3% discount rate to costs. The ICER per language and motor development score gained was $22 and $20, respectively, with a 3% discount rate to costs. INTERPRETATION The intervention was cost-effective: the ICER per child cognitive development score gained was 0·5% of Viet Nam's gross domestic product per capita, alongside other benefits in language and motor development. This finding supports the scaling up of this intervention in similar socioeconomic settings. FUNDING Australian National Health and Medical Research Council and Grand Challenges Canada. TRANSLATION For the Vietnamese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trang Nguyen
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Stanley Luchters
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David B Hipgrave
- UNICEF, Baghdad, Iraq; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Hanieh
- Department of Medicine and Victorian Infectious Diseases Service at the Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Tuan Tran
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Ha Tran
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Beverley-Ann Biggs
- Department of Medicine and Victorian Infectious Diseases Service at the Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Johnson T, Usherwood T, Redfern J. Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation. Contemp Clin Trials 2022; 118:106794. [PMID: 35589026 PMCID: PMC9110058 DOI: 10.1016/j.cct.2022.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Practice-level quality improvement initiatives using rapidly advancing technology offers a multidimensional approach to reduce cardiovascular disease burden. For the "QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease" (QUEL) cluster randomised controlled trial, a 12-month quality improvement intervention was designed for primary care practices to use data and implement progressive changes using "Plan, Do, Study, Act" cycles within their practices with training in a series of interactive workshops. This protocol aims to describe the systematic methods to conduct a process evaluation of the data-driven intervention within the QUEL study. METHODS A mixed-method approach will be used to conduct the evaluation. Quantitative data collected throughout the intervention period, via surveys and intervention materials, will be used to (1) identify the key elements of the intervention and how, for whom and in what context it was effective; (2) determine if the intervention is delivered as intended; and (3) describe practice engagement, commitment and capacity associated with various intervention components. Qualitative data, collected via semi-structured interviews and open-ended questions, will be used to gather in-depth understanding of the (1) satisfaction, utility, barriers and enablers; (2) acceptability, uptake and feasibility, and (3) effect of the COVID-19 pandemic on the implementation of the intervention. CONCLUSION Findings from the evaluation will provide new knowledge on the implementation of a complex, multi-component intervention at practice-level using their own electronic patient data to enhance secondary prevention of cardiovascular disease. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,Corresponding author at: The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Level 6, Block K, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,Department of Cardiology, Concord Hospital, ANZAC Research Institute, Sydney, Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, Australia
| | - Clara K. Chow
- Western Sydney Local Health District, Sydney, Australia,Westmead Applied Research Centre, Faculty of Medicine and Health, Westmead, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christopher M. Reid
- School of Public Health, Curtin University, Perth, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nicholas Zwar
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia,The George Institute for Global Health, School of Public Health, Imperial College London, UK
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Emily R. Atkins
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, Australia
| | | | | | - Timothy Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia,Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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