Bridging community and facility care: cost-effectiveness of implementing 2019 childhood pneumonia management guidelines in India

OBJECTIVE: The present study evaluates the cost-effectiveness of India's 2019 childhood pneumonia management guidelines compared with no treatment, assuming 100% coverage, from a health system perspective. METHODOLOGY: The cost-effectiveness analysis parameterised a decision tree model in Microsoft Excel to estimate the incremental cost and effectiveness. Costing followed the normative approach, guided by national guidelines and the Indian Public Health Standards (IPHS) 2022, to define the types and quantities of resources. Published literature informed epidemiological inputs. Health effects were estimated as disability-adjusted life years (DALY) averted, using the World Health Organisation (WHO) DALY calculation template. The analysis discounted future health outcomes and capital costs at 3% to account for time preference. We reported our results as incremental cost per DALY averted. A probability sensitivity analysis in R software was conducted to estimate the joint effect of parameter uncertainties. RESULTS: Treating fast-breathing pneumonia in accordance with the 2019 national childhood pneumonia management guideline incurs an incremental cost of 7.83 USD per DALY averted. For possible serious bacterial infections (PSBI), the cost-effectiveness varies by severity and treatment regimen. When managed in an outpatient setting, the additional cost per DALY averted is 2.1 USD, whereas treating PSBI in an inpatient (standard) setting increases the additional cost per DALY averted to 11.6 USD. CONCLUSION: India's national childhood pneumonia management guidelines are highly cost-effective and should be scaled up nationwide to reduce the pneumonia burden and improve child survival.