Cost-effectiveness analysis and mortality impact estimation of scaling-up pregnancy test kits in Madagascar, Ethiopia and Malawi
Résumé
Cost-effective, innovative approaches are needed to accelerate progress towards ending preventable
infant, child and maternal mortality. To inform policy decisions, we conducted a costeffectiveness
analysis of adding urine pregnancy test kits to the maternal and reproductive services
package offered at the community level in Madagascar, Ethiopia and Malawi. We used a decision
tree model to compare the intervention with the status quo for each country. We also completed
single factor sensitivity analyses and Monte Carlo simulations with 10 000 iterations to generate
the probability distribution of the estimates and uncertainty limits. Among a hypothetical cohort of
100 000 women of reproductive age, we estimate that over a 1-year period, the intervention would
save 26, 35 and 48 lives in Madagascar, Ethiopia, and Malawi, respectively. The Incremental Cost
Effectiveness Ratio (ICER) for the cost per life saved varies by country: $2311 [95% Uncertainty
Interval (UI): $1699; $3454] in Madagascar; $2969 [UI: $2260; $5041] in Ethiopia and $1228 [UI:
$918; $1777] in Malawi. This equates to an average cost per Disability Adjusted Life Year (DALY)
averted of $36.28, $47.95 and $21.92, respectively. Based on WHO criteria and a comparison with
other maternal, newborn, and child health interventions, we conclude that the addition of urine
pregnancy tests to an existing community health worker maternal and reproductive services package
is highly cost-effective in all three countries. To optimize uptake of family planning and antenatal
care services and, in turn, accelerate the reduction of mortality and DALYs, decision makers
and program planners should consider adding urine pregnancy tests to the community-level package
of services.