Cost‐effectiveness of a weaning food safety and hygiene programme in rural Gambia

Summary Objective The main objective of the economic evaluation was to determine the cost‐effectiveness of a weaning food safety and hygiene programme in reducing rates of diarrhoea compared with the control in rural Gambia. Methods The public health intervention, using critical control points and motivational drivers, was evaluated in a cluster randomised controlled trial at 6‐ and 32‐month follow‐up. An economic evaluation was undertaken alongside the RCT with data collected prospectively from a societal perspective. Decision‐analytic modelling was used to explore cost‐effectiveness over a longer time period (4 years). Results Direct out‐of‐pocket healthcare expenditure for households due to diarrhoea was large. The intervention significantly reduced reported childhood diarrhoeal episodes after 6 months (incident risk ratio = 0.40, 95% CI 0.33, 0.49) and 2 years after the intervention (incident risk ratio = 0.68, 95% CI 0.46, 1.02). The within‐trial analysis found that the intervention led to total savings of 8064 dalasi 6 months after the intervention and 4224 dalasi 2 years after the intervention. Based on the model results, if the intervention is successful in maintaining the reduction in the risk of diarrhoea, the ICER is US$ 814 per DALY avoided over 4 years. This is cost‐effective. Conclusions This study suggests that there are substantial household costs associated with diarrhoeal episodes in children. The within‐trial analysis and model results suggest that the community‐based approach to improving weaning food hygiene and safety is likely to be cost‐effective compared with control.