EC Paediatrics

Objectives: Anemia is a major public health problem in India. A cluster-randomized trial (cRCT) is undergoing in rural Telangana, India, to evaluate a ‘Screen and Treat for Anemia Reduction (STAR)’ approach using population-level screening for anemia using point of care diagnostic methods followed by appropriate treatment.

Methods: Here we describe the economic evaluation protocol of this approach, to be conducted alongside the cRCT. This will address the question of whether the approach will be a cost-effective intervention for increasing population mean hemoglobin and reducing the prevalence of anemia among pregnant women and children (6 months - 5 years age), as compared with the existing anemia control program alone. A cost-utility analysis (CUA) will be conducted to explore and quantify the costs per health gain using a societal perspective, considering costs and outcomes relevant to the public health department and the study population and quality of life (QoL) of the population in the intervention group using the EQ-5D-5L tool. The relative costs and outcomes will be assessed using the incremental cost-effectiveness ratio (ICER) in cost per percentage point reduction in anemia prevalence across the two approaches and cost per percentage point increase in the population mean hemoglobin, for the combined 6-month prevalence of anemia and cost per quality-adjusted life-years gained. Decision-analytic modelling to estimate cost-effectiveness beyond the trial period, will also be conducted.

Results and Conclusion: The results of this economic evaluation would help policymakers make an informed decision regarding this strategy for anemia reduction.

Keywords: Anemia; cRCT; Health Economics; CEA; Protocol

1. NM Nils Milman. “Anemia--still a major health problem in many parts of the world!” Annals of Hematology 90 (2011): 369-377.
2. WHO | Worldwide prevalence of anaemia 1993-2005. WHO (2021).
3. Nguyen PH., et al. “Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006 to 2016”. BMJ Global Health 3 (2018): e001010.
4. WHO | Global anaemia prevalence and number of individuals affected. WHO (2021).
5. Kumari S., et al. “Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India”. One Health (2019): 8.
6. Dandona R., et al. “A review of national health surveys in India”. Bulletin of the World Health Organization 94 (2016): 286-296A.
7. Suri S. “NFHS-5 data reiterates the challenge of breaking the Intergenerational Cycle of Undernutrition”. ORF (2021).
8. Overall indicators for women improve, but anaemia worsens in state: NFHS-5. Indian Express (2020).
9. Fact Sheet_TG (2021).
10. Anemia Mukt Bharat. “A programme by Ministry of Health and UNICEF”. Anemia Mukt Bharat Dashboard (2021).
11. Kapil U., et al. “National Iron Plus Initiative: Current status and future strategy”. Indian Journal of Medical Research 150 (2019): 239-247.
12. Bhatia V., et al. “Operational issues and lessons learned during National Iron Plus Initiative documentation in Eastern India”. Indian Journal of Community and Family Medicine 5 (2019): 10.
13. Kulkarni B., et al. “Screen and Treat for Anaemia Reduction (STAR)’ strategy: study protocol of a cluster randomised trial in rural Telangana, India”. BMJ Open 11 (2021): e052238.
14. Adamiak G. “Methods for the economic evaluation of health care programmes, 3rd edition”. Journal of Epidemiology and Community Health 60 (2006): 822-823.
15. Kim Y-J., et al. “Anemia and health-related quality of life in South Korea: data from the Korean national health and nutrition examination survey 2008-2016”. BMC Public Health 19 (2019): 735.
16. Dasi T., et al. Point-of-care Hb measurement in pooled capillary blood by a portable autoanalyser: comparison with venous blood Hb measured by reference methods in cross-sectional and longitudinal studies (2021): 1-10.
17. Herdman M., et al. “Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)”. Quality of Life Research 20 (2011): 1727-1736.
18. Kularatna S., et al. “Mapping Sri Lankan EQ-5D-3L to EQ-5D-5L Value Sets”. Value Health Reg Issues 12 (2017): 20-23.
19. Ride J., et al. “Protocol for economic evaluation alongside a cluster-randomised controlled trial of a psychoeducational intervention for the primary prevention of postnatal mental health problems in first-time mothers”. BMJ Open 4 (2014): e006226.
20. The COMET Handbook: version 1.0 | Trials | Full Text (2021).
21. Briggs AH. “Statistical approaches to handling uncertainty in health economic evaluation”. European Journal of Gastroenterology and Hepatology 16 (2004): 551-561.
22. Representing uncertainty: the role of cost‐effectiveness acceptability curves - Fenwick - 2001 - Health Economics - Wiley Online Library (2021).
23. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery | Cost Effectiveness and Resource Allocation | Full Text (2021).