Economic evaluation of home-based counselling to promote exclusive breastfeeding in Egypt

Abstract BackgroundHome-based counselling interventions to scale up exclusive breastfeeding (EBF) rates have been shown to be effective in many countries. However, there is limited data regarding its effectiveness and cost-effectiveness in the Egyptian context. This study calculates the economic burden of not breastfeeding in Egypt, followed by an economic evaluation of a modelled intervention targeting new mothers to promote exclusive breastfeeding rates for 6 months. MethodsBoth monetary and non-monetary units of measurement were used to estimate the burden attributed to non-EBF due to diarrheal diseases, lower respiratory tract infections, and acute otitis media. Morbidity and mortality indicators: incidence, prevalence, and deaths were calculated then time lost measures. In addition, both the cost of illness and the value of statistical life approaches were used to reflect the burden of the diseases attributed to non-EBF in monetary terms. A modelled home-based breastfeeding counselling intervention is adopted from the literature. The effectiveness of this intervention was based on 4 scenarios of decreasing the DALYs lost due to the 3 diseases attributed to non-EBF by 40%, 20%, 10%, and 5%. This is followed by conducting different economic evaluation analyses: cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis to determine the cost-effectiveness of this intervention. ResultsThe cost of illness approach was calculated to be about 1.8 billion EGP in 2019. However, the value of statistical life approach revealed that the society’s willingness to pay to avoid the DALYs lost due to 3 diseases attributed to non-EBF ranged from 10 to 32 billion EGP. All the economic evaluation analyses showed that this home-based counselling intervention is cost-effective to scale up breastfeeding rates in Egypt with an incremental cos-utility ratio (ICUR) ranges from 5,520 to 44,158 EGP per each DALY averted. In addition, it will lead to annual benefits up to 12.4 billion EGP and a return on investment up to 28.8 EGP for each 1 EGP invested in this intervention. ConclusionHome-based counselling intervention is a very cost-effective intervention in promoting exclusive breastfeeding rates in Egypt. It is also a good investment for the government with a significant return on investment and huge cost savings.