Cost-effectiveness and affordability of community mobilisation through women’s groups and quality improvement in health facilities (MaiKhanda trial) in Malawi

Table 1 Costs and effects of community, facility and combined interventions

Parameter	Community intervention (CI; 2 arms)	Facilities intervention (FI; 2 arms)	Combined FICI ^d		Source
			(1 arm)	(2 arms)
Total population (babies and mothers)	1,200,000 (108,000)	1,200,000 (108,000)	600,000 (54,000)	1,200,000 (108,000)
Comparisons data used for:	CI vs. current practice; CI vs. FI vs. FICI	FI vs. current practice; CI vs. FI vs. FICI	FICI vs. current practice	CI vs. FI vs. FICI
Start-up cost, beginning ($)	362,083	362,860	362,472	724,943	MaiKhanda accounts
Maintenance costs, annual, on-going ($ per year)	27,250	25,328	26,289	52,578
Annual implementation costs ($ per year)	2,068,997	2,026,811	2,047,904	4,095,808
External costs ($ per year)	120,067	272,017	196,042	392,084	Estimated^a
Total cost (27-month trial period)	5,348,791	5,592,212	5,470,501	10,941,002	Start-up, recurring and external costs
Baby mortality (OR, 95% CI)	0.873 (0.774, 0.982)	0.954 (0.846, 1.070)	0.841 (0.707, 0.992)	0.841 (0.707, 0.992)	model of cRCT data (Additional file 1)
Mother mortality (OR, 95% CI)	0.957 (0.494, 1.657)	1.228 (0.652, 2.135)	1.287 (0.488, 2.839)	1.287 (0.488, 2.839)
Babies saved^b (mean, 95% CI)	772 (109, 1384)	291 (−439, 974)	475 (23, 880)	951 (46, 1760)
Mothers saved^b (mean, 95% CI)	18 (−270, 210)	−97 (−480, 148)	−62 (−397, 112)	−124 (−793, 223)
DALYs averted^c (mean, 95% CI)	67361 (8808, 121508)	19901 (−44769, 80586)	37590 (−4642, 74618)	75180 (−9284, 149236)

$ constant 2013 international dollars; OR = Odds Ratio (mean); 95% CI = 95% Credibility Interval (2.5th centile, 97.5 centile); DALY = Disability Adjusted Life Year.
^aFrom specific expatriate staff grades, percentage full-time and length of time working on the project, travel and hotel costs.
^bOut of 108,000 for CI and FI, which is the estimated total population of babies and mothers in the relevant groups of two trial arms (CI, no CI, FI, no FI) in 27 months (2.25 years). This is the estimated total population of 1,200,000 (based on average size of health centre catchment area (cluster) [5]) multiplied by an estimated Crude Birth Rate (CBR) of 0.04 per person per year [2] for 2.25 years. For combined FICI it is out of 54,000, the estimated total population of babies and mothers in the relevant groups of one trial arm (FICI and control [5]).
^c86.0 DALY averted per baby saved and 53.27 DALY averted per mother saved, see text for explanation.
^dNote that the estimated costs and effects for FICI (first FICI column) were doubled (second FICI column) in order to compare the cost-effectiveness of FICI with the cost-effectiveness of CI and FI (Figure 4).

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