Reducing regional health inequality: a sub-national distributional cost-effectiveness analysis of community-based treatment of childhood pneumonia in Ethiopia

Abstract Background Increasing the coverage of community-based treatment childhood pneumonia (CCM) is part strategy to improve child survival, increase life-expectancy at birth and promote equity in Ethiopia. However, full CCM has not been reached any regions country. There are no sub-national cost-effectiveness analyses available inform decision makers on most equitable scale up strategy. Objectives Our first objective estimate interindividual inequality impacts scaling coverages 90% each region. second explore costs, health effects, geographical associated with three scale-up scenarios promoting different policy-aims: maximizing health, reducing inequalities, achieving universal coverage. Methods We used Markov modelling All data were collected through literature review adjusted region-specific proportions rural population. Health effects modeled as life years gained under-five deaths averted. Interindividual measured by GINI index applied health. In scenario analysis we explored strategies: 1) prioritizing where intervention was cost-effective, 2) inequalities high baseline mortality rate (U5MR), 3) upscaling all regions. Results The regional incremental-cost effectiveness ratio (ICER) varied from 26 USD per year Addis 199 Southern Nations, Nationalities, Peoples’ Universal would cost about 1.3 billion prevent 90,000 deaths. This less than 15,000 saved translates an expectancy 1.6 across analysis, found that U5MR effective although fewer lives compared Conclusions model results illustrate a trade-off between two common policy-aims low-income settings.