Is home management of fevers a cost‐effective way of reducing under‐five mortality in Africa? The case of a rural Ghanaian District

Objective To assess the cost‐effectiveness of two strategies of home management of under‐five fevers in Ghana – treatment using antimalarials only (artesunate–amodiaquine – AAQ) and combined treatment using antimalarials and antibiotics (artesunate–amodiaquine plus amoxicillin – AAQ + AMX). Methods We assessed the costs and cost‐effectiveness of AAQ and AAQ + AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step‐wedged design. Approximately, 12 000 children aged 2–59 months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under‐five deaths averted and disability‐adjusted life years (DALYs) averted as effectiveness measures. Results Total economic costs for the interventions were US$ 204 394.72 (AAQ) and US$ 260 931.49 (AAQ + AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ + AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ + AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ + AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ + AMX). Conclusion Both AAQ and AAQ + AMX approaches were cost‐effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost‐effective. Home management of under‐five fevers in rural settings is cost‐effective in reducing under‐five mortality.