Cost and consequences of using 7.1% chlorhexidine gel for newborn umbilical cord care in Kenya

Abstract Background: Umbilical-cord infection (omphalitis) is a major cause of neonatal mortality in Kenya. Chlorhexidine 7.1% digluconate gel, (CHX), delivering 4% chlorhexidine was identified as a life-saving commodity for newborn cord care by the United Nations and is included on the World Health Organization and Kenyan Essential Medicines Lists. Methods: We employed a cost-consequence model to assess resource saving and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Economic outcomes associated with omphalitis cases avoided were then determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Costs and other inputs were sourced from the literature and supplemented by expert clinical opinion/informed inputs, making assumptions as necessary. Reports: The model estimated that, over 1 year, ~23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~13,000 outpatient visits, ~43,000 bed days and preserving ~114,000 workdays. CHX was associated with annual direct cost savings of ~590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and of 5.43 USD/course when also including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of the impacts of upscaling CHX use more robust.