Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso

Abstract

Introduction: Child health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale.

Methods: We collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012-2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention's incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD.

Results: The provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI -38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018-2020, varied between $7 in Malawi to $27 in Burundi.

Conclusion: This study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale.

Trial registration number: NCT01517230; Results.

Keywords: child health; cluster randomized trial; health economics; health education and promotion.

Conflict of interest statement

Competing interests: RH is the CEO of DMI. JM is an employee of DMI and JS is a former employee of DMI. The other authors declare no conflict of interest.

Figures

Figure 1

Tornado diagram of the percentage change in the base case ICER from one-way sensitivity analyses of key input variables. Light blue bars indicate that the input variable was at its minimum plausible value, whereas dark blue bars indicate that the input variable was at its maximum plausible value. The relative impact on the ICER is illustrated through the magnitude of the bars and the indicated percentages. ICER, incremental cost-effectiveness ratio.

Figure 2

Acceptability curve. In our PSA, the within-trial analysis of the mass media campaign in Burkina Faso had a less than 1% probability of being ‘highly attractive’ but an 93% probability of being ‘attractive’ as per the generic low-income country thresholds suggested by the World Bank in 1993, updated to 2015 USD. It had a >99% probability of being ‘highly cost-effective’ in Burkina Faso based on the WHO-CHOICE suggested threshold of the country’s GDP per capita. DALY, disability-adjusted life year; GDP, gross domestic product; ICER, incremental cost-effectiveness ratio; PSA, probabilistic sensitivity analysis.