Economic evaluation of the integrated care model and its scalability in Zimbabwe
Maxwell Mhlanga, Midion Chidzonga and Clara Haruzivishe
Background: Researchers and policy makers in middle to low income countries still face challenges in recommending the community models that are cost-effective, sustainable and that can be integrated into the mainstream community health care systems. Many community models have failed this acid test as they either only prove to be effective at pilot-stage life but the gains fail to be sustained in pragmatic situations. This study sought to determine the cost-effectiveness of the Integrated Care Model by doing an economic analysis comparing the Integrated Care Model and the conventional health care mobilisation system in Zimbabwe.
Methods: The economic evaluation was conducted with a pragmatic trial that employed the quasi-experimental approach to determine the long term effectiveness of the Integrated Care Model in improving Child health outcomes in Zimbabwe. Villages from two health centres we randomised either to the intervention or control arm. Average Cost effective ration and Incremental Cost Effectiveness ratios were used to assess and compare the cost-effectiveness of the two interventions.
Results: The overall ACER for the intervention and the control were 8 412 and 31 618 respectively whereas the overall ICER was 27 212 for Figure 4 below is a representation of the average cost effectiveness ratio for all the disease condition and Figure 5 is a depiction of the ICERs for the study conditions. The overall risk of morbidity was 0.9 in the intervention and 5.8 in the control giving a risk ratio of 6.8 (95% CI (5.94 - 7.77), P< 0.0001). We used the CEA four plane model to determine the overall effectiveness of the intervention. Figure 7 below is a graphical representation of our results on a cost-effectiveness plane plotting net-cost against effect. The study of the net-cost against intervention effect revealed that the study intervention falls in the lower right quadrant, meaning that the intervention is cost-effective (More effective and less costly).
Conclusion: The study results revealed that the Integrated Care Model is a cost-effective model that can improve child health outcomes in low-resource settings. Governments in low to medium income countries can scaling up such low cost-high impact interventions.