Economic model
reduced disease
DISEASES
We deduced the total incremental cost of activating CHVs in the health system over the next 10-year period. In Economic model for cost.In addition to financial costs, we also reflected various economic costs in our model, including the time spent by caregivers, CHVs, CHOs, the monitoring staff of Ghana Health Service, and project consultants. Finally, the total incremental cost was converted to a constant 2016 US dollars ($1 = GHS 3.91) and discounted annually by 3% [Parameters for economic model (cost).* More detail information on the parameters is included in the supplementary material #1.In Economic model for effectiveness.First, in the statistical model, the relative risk of diseases between the two groups was inferred, and the relative risk reduction was derived by subtracting 1 from the relative risk. Second, the reduced disease cases in the target population (intervention group) were calculated from the combined probability of the relative risk reduction and the average incidence of diseases in the intervention group. Third, we calculated the number of averted DALYs in the target population during a 1-year cycle by proportionally shifting the reduced disease cases to mild, moderate, severe, and fatal states. Finally, the total expected incremental DALYs over the 10-year period was calculated by applying the annual population growth rate of 2.2%, the discount rate of 3% and the CHVs’ attrition rate of 8.3% to the 1-year cycle economic model for ten times. We estimated the attrition rate of CHVs based on field research in rural Ghana finding that after activating CHVs, they began to deactivate at an attrition rate of 8.3% per year and did not remain active in the community after 10 years.We evaluated the incremental cost-effectiveness of our model with the incremental cost-effective ratio (ICER) per DALY and the probability of accepting the cost-effective thresholds (CETs). We set up five CETs to reflect variation in policymakers’ willingness-to-pay. The first and second CETs (20% and 50% of GDP per capita) were selected with reference to previous studies investigating CETs based on opportunity costs in low- and middle-income countries [Parameters for economic model (probabilistic).Parameters for economic model (constant).In Economic model for benefit.