Health Economic Evaluation Of Comprehensive Management Of Childhood Diseases In Rural Areas Of Hebei Province

BackgroundIn the past2decades, the children development level in China has been improved and malnutrition rate has been reduced. Even though there exists huge health gap between children in urban cities and those in rural China. Surveys reveal that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised. Effective measure against these problems should be work out.IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. IMCI has been listed in Chinese Children's Development Programme (2010-2020) as the key strategy for children health status improvement in rural China.The national primary public health services and IMCI overlaps partially, which arouse the question that "Whether IMCI would bring additional benefit in children's health improvement? Is IMCI still cost-effective when national basic public health services have already been provided?"The systematic review indicated that the current studies failed to provide solid evidence for cost-effectiveness of IMCI in China. Whether IMCI is appropriate and cost-effective to be implemented in rural China is still unknown.ObjectivesThis study aims to evaluate the costs and the effectiveness of IMCI implemented in Hebei province of China, and to provide the suggestion for further implement of IMCI in rural China.Contents1. The IMCI outcomes:health worker performance and their quality of care, and family health practices, and the availability of drugs, vaccine and basic medical devices.2. The IMCI costs:IMCI-related the intervention costs, facility-level costs and household-level costs.3. The cost-effectiveness of IMCI and incremental cost-effectiveness ratio of key indicators.MethodsThe sampling method and sample size calculation were based on the requirement of the randomized control trial, with townships as the randomization unit (8townships per group). For the household survey, the surveyed children were selected using a two-stage sampling procedure. In the first stage, clusters were selected using Proportional to Population Size (PPS) sampling, with10clusters chosen from each township (160clusters from138villages in total, with some big villages having more than1cluster). In the second stage, the name list of all eligible children under two years old in each cluster was obtained and13children per clusters were randomly selected using Microsoft Excel software. The sample size was calculated as800children under2years old per group to detect the difference of primary outcomes between the intervention and control groups, however, we over-sampled30%children to compensate the possible refusal and absence.Effective Matrixes have been developed to systematically evaluate the benefits brought by IMCI; Difference in Difference Estimation Regression has been applied to measure to net IMCI intervention benefits.ResultsThe total intervention cost of IMCI is73,150RMB, and the avg. intervention cost per child is3.85RMB. The total cost of IMCI group is34.81RMB per child, which is a little expensive than the control group with29.55RMB per child. IMCI brought significant improvement of effective matrixes in health workers case management skills(8.239/14), communication skills(2.25/5) and diagnostic accuracy(0.363/6), with ICER values8782,29038and75568, respectively. The improvement of family care-seeking practices has also been observed. Discussion1. IMCI can improve health workers case management skills, while the use of IMCI recommend antibiotics and oral rehydration salts(ORS) should be strengthened.2. IMCI can improve family care-seeking practice.3. IMCI is good value for money.Suggestion1. It'necessary to combine the IMCI and the national primary public health services, in order to avoid the overlap of the health care for children.2. To build a performance evaluation mechanism and subsidize the IMCI health workers.3. To conduct a long-term evaluation of IMCI, and to explore the long-term impact it has on children health and mortality in China.