Cost effectiveness of home-based chlorination and safe water storage in reducing diarrhea among HIV-infected households in rural Uganda.

This study examined the cost-effectiveness of a safe water system (SWS) for HIV-affected households using health outcomes and costs from a randomised controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhoea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhoea episodes and 310 diarrhoea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net programme costs were $5.21/episode averted, $0.62/diarrhoea-day averted, and $1,252/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhoea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhoea-related mortality, diarrhoea incidence, and effective clinical management. American Journal of Tropical Medicine and Hygiene 2006;74:884-90.