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COST ANALYSIS, COST SAVINGS, AND COST EFFECTIVENESS ANALYSIS OF KANGAROO MOTHER CARE: A SYSTEMATIC
REVIEWDenny John, Somashekhar Nimbalkar, Jianguo Zhou, Kushal Shah
1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Lancet Every Newborn Study Group. Every Newborn: progress, priorities, and potential beyond survival. Lancet2014;384(9938):189-205.
2. Sharma D, Murki S, Oleti TP. To compare growth outcomes and cost-effectiveness of “Kangaroo ward care” with “intermediate intensive care” in stable extremely low birth weight infants: Randomized control trial. The Journal of Maternal-Fetal & Neonatal Medicine 2016; DOI: 10.1080/14767058.2016.1220531
CONTACT : Prof. Somashekhar Nimbalkar, Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand-Gujarat. Pin-388325, Email: [email protected] Mobile: +91 98250 87842 Conflict of Interest: None Funding Source: None
BACKGROUNDDescription of the condition• Neonatal period is the most vulnerable for child’s survival. Small size at birth is the biggest risk factor for more than 80% of neonatal
deaths, and increases risk of post-neonatal mortality, growth failure, and adult-onset non-communicable diseases [1]. • LBW infants born in hospitals are kept in incubators or radiant warmers which is expensive and time consuming.Description of the interventionKMC is an early, prolonged and continuous skin-to-skin contact between the mother and the LBW infant both in hospital and after discharge, with exclusive breastfeeding and proper follow up.
OBJECTIVESPrimary objective was to review and summarize the available evidence on cost analysis, cost savings, and cost effectiveness of KMC.
CONCLUSIONThe very few evidences that do exist suggest that KMC can be cost saving and cost effective in low and middle-income countries.
PICO(S)Population LBWs, VLBI, neonatesIntervention LBWs, VLBIs, neonates receiving KMCComparators No KMC, Other careOutcomes Costs, cost savings, cost effectiveness analysisStudy designs RCTs, quasi-RCTs, Cohort, Costing, Cost of
illness, Economic modelling , Budget impact
SEARCH: 3-5 September 2016• Databases: Pubmed, Ovid-Medline, EBSCO, Cochrane
Library, Embase, NHS EED, and CEA Registry• WHO regional databases and Google Scholar• Contacted KMC researchers around the world• Back searching of Cochrane Review and HTA report
STUDY SELECTION• Pre-specified inclusion/exclusion criteria according to
PICO. • Two reviewers screened titles, abstracts and full text.
INCLUDED STUDIES • Descriptive=1• Cost analysis=2• Cost effectiveness analysis=5
183 unique titles retrieved
8 studies included
DATA EXTRACTION & QUALITY ASSESSMENT• One reviewer extracted using a tailored form• Critical appraisal using CASP Economic Evaluation
Checklist
RESULTSCOST ANALYSIS STUDIES• KMC was found to be 50%- 70% cheaper than CMC across the
studies. • The length of stay for KMC LBWI was significantly lower
compared to CMC. ECONOMIC EVALUATION (EE) STUDIES• Broughton (2013) conducted a cost-minimization analysis ,
showing savings after one year of implementation, with savings between US$233000-US$166000 annually.
• Entringen (2013) stated the budget impact of KMC for 1000 newborns as R$6795661.30. The daily costs was found to be 13% lower of second stage KM compared to Neonatal IU.
• Two studies from India conclude KMC to be a cost-effective measure with cost savings ranging from US$450-US$512 due to the initiation of early shifting of babies to Kangaroo Care Ward. [2]
DISCUSSION• The main reasons for cost savings are the lower need for
materials and supplies, drugs, oxygen, and lower proportion of staff time devoted due to KMC.
• The empirical evidence of cost savings and cost effectiveness is currently limited to only hospital-based KMC programs
STUDY IMPLICATIONPolicy makers should ensure that proper guidelines are in place with adequate budgetary provision to ensure the implementation of KMC across all types of health facilities, both private and public.
