Scale-up of amoxicillin dispersible tablet in the management of uncomplicated childhood pneumonia in Nigeria: A cost-benefit analysis

Background: In Nigeria, about 19% of children under five die of pneumonia every year. The World Health Organisation (WHO) recommends the use of oral amoxicillin dispersible tablet (DT) as the first‐line agent in its management. Some parents may be unable to procure the medication for a full treatment course due to other competing needs. In pursuant of SDG‐3 and the African Union Agenda, 2063, there is need for external support. Objectives: The principal objective of this study is to evaluate the cost and benefit of implementing amoxicillin DT in management of childhood pneumonia in Nigeria and to determine if scale‐up of treatment will be worthwhile. Methods: The study was a cost‐benefit analysis using simulation‐based decision‐analytic Markov model for the Nigerian setting and a sample size of 34.6 million children at risk of having pneumonia. The study used retrospective data and cost analysis was from the payer's perspective. Amoxicillin DT was the intervention used in the study. Health outcome was expressed in terms of disability adjusted life years (DALY) averted and converted to monetary terms (benefits). Both cost and benefit were expressed in US dollars. Data was analysed using Microsoft excel 2007. Distribution appropriate to each parameter was used in the analysis. Results: The mean cost of management of pneumonia was $0.47 while the mean DALYs averted was 0.006. With a 2018 GNI per capita of $1960, the Benefit‐cost ratio (BCR) obtained is 31. The annual benefit of scale‐up of amoxicillin DT will be $153 million per annum. Conclusions: There is a significant benefit with amoxicillin DT in the management of pneumonia in a high prevalent country like Nigeria. Scale‐up of treatment has the potential to generate high returns on investment and should be considered especially in far‐to‐reach areas in Nigeria.