Considering equity and cost-effectiveness in assessing a parenting intervention to promote early childhood development in rural Vietnam

Author:

Baek Yeji1ORCID,Ademi Zanfina12ORCID,Tran Thach1ORCID,Owen Alice1ORCID,Nguyen Trang3ORCID,Luchters Stanley45ORCID,Hipgrave David B6ORCID,Hanieh Sarah7ORCID,Tran Tuan3ORCID,Tran Ha3ORCID,Biggs Beverley-Ann7ORCID,Fisher Jane1ORCID

Affiliation:

1. School of Public Health and Preventive Medicine, Monash University , 553 St Kilda Road, Melbourne, Victoria 3004, Australia

2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University , 381 Royal Parade, Parkville, Victoria 3052, Australia

3. Research and Training Centre for Community Development (RTCCD) , No. 6, Alley 46, Tran Kim Xuyen Street, Trung Hoa, Cau Giay District, Hanoi 10000, Vietnam

4. Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) , 4 Bath Road, Harare, Zimbabwe

5. Liverpool School of Tropical Medicine (LSTM) , Pembroke Place, Liverpool L3 5QA, UK

6. UNICEF Iraq , Karadat Maryam District, Haifa Street, Baghdad 10011, Iraq

7. The Peter Doherty Institute for Infection and Immunity, University of Melbourne , 792 Elizabeth Street, Melbourne 3000, Australia

Abstract

Abstract Considering equity in early childhood development (ECD) is important to ensure healthy development for every child. Equity-informative cost-effectiveness analysis can further guide decision makers to maximize outcomes with limited resources while promoting equity. This cost-effectiveness study aimed to examine the equity impacts of a multicomponent ECD intervention in rural Vietnam. We estimated the cost-effectiveness of the intervention with a 30-month time horizon from the service provider and household perspectives with equity considerations. Data were from a cluster-randomized controlled trial comparing the intervention with the local standard of care. The incremental cost-effectiveness ratios (ICERs) per child cognitive development score gained were estimated by household wealth quintile and maternal education level, adjusted for cluster effects and baseline characteristics such as maternal parity and age. A 3% discount rate was applied to costs, and non-parametric cluster bootstrapping was used to examine uncertainty around ICERs. Children in the intervention had higher cognitive development scores than those in the control arm across all subgroups. Based on intervention recurrent cost, the ICER per cognitive development score gained was lower in children from the poorest quintile (−US$6) compared to those from the richest quintile (US$16). Similarly, the ICER per cognitive development score gained was lower in children whose mothers had the lowest education level (−US$0.02) than those with mothers who had the highest education level (US$7). Even though our findings should be interpreted with caution due to the insufficient study power, the findings suggest that the intervention could promote equity while improving child cognitive development with greater cost-effectiveness in disadvantaged groups.

Funder

Australian National Health and Medical Research Council

Grand Challenges Canada

Publisher

Oxford University Press (OUP)

Subject

Health Policy

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