Cost-effectiveness of home-based chlorination and safe water storage in reducing diarrhea among HIV-affected households in rural Uganda
Shrestha, R.K.; Marseille, E.; Kahn, J.G.; Lule, J.R.; Pitter, C.; Blandford, J.M.; Bunnell, R.; Coutinho, A.; Kizito, F.; Quick, R.; Mermin, J.
American Journal of Tropical Medicine and Hygiene 74(5): 884-890
2006
ISSN/ISBN: 0002-9637 PMID: 16687697 Document Number: 601119
Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were $5.21/episode averted, $0.62/diarrhea-day averted, and $1,252/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been $11/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.