Cost-effectiveness and user characteristics of clinic based services for the treatment of diarrhea: a case study in Bangladesh

This study compares the cost-effectiveness of three services for the treatment of diarrhea, in a rural area of Bangladesh. It also examines patterns of user composition, and how these depend on factors other than disease severity and incidence. The three services are a large hospital-style treatment center, an ambulance system bringing patients from greater distances, and a small treatment center staffed by paramedics. The results show that the long run average cost per patient is about +16 at the large center, with an additional +13 if the patient came by ambulance, compared to +3 at the small center. Corresponding costs per death averted were +1300, an additional +360, and +190 respectively. Previous studies have suggested that there is no more cost-effective alternative for the prevention of diarrhea, although in future home-based oral rehydration therapy may be a potential alternative. Each service exhibits use patterns suggesting that males and especially small boys receive preferential access to treatment. This bias is exacerbated as distance from the center increases, or if a fee is charged. The study concludes firstly that diarrhea treatment costs in clinics are relatively high, and secondly that unintended biases in service use should be an important consideration in service design.