Cost-effectiveness of antenatal corticosteroids for women at risk of imminent preterm birth in the early preterm period in low resource countries

Dexamethasone tablets

Antenatal corticosteroids (ACS) are administered to pregnant women at risk of preterm birth, to improve health outcomes for the preterm newborn. To address a lack of evidence for this important intervention in low-resource hospitals, WHO established an international research collaboration to conduct hospital-based, placebo-controlled efficacy trials of ACS (dexamethasone) in Bangladesh, India, Kenya, Nigeria and Pakistan. This collaboration recently completed the WHO ACTION-I Trial, which showed that dexamethasone (a corticosteroid) is safe and effective for this indication.

This follow-up study will establish the additional economic evidence required for the adoption of ACS in health benefits packages. Specifically, we will address the following aims:

  1. Cost-effectiveness of ACS: Estimate the cost per disability-adjusted life year (DALY) averted from ACS use in Bangladesh, India, Kenya, Nigeria and Pakistan.
  2. Affordability of ACS: Estimate the total additional annual cost of including ACS into the health benefits packages of Bangladesh, India, Kenya, Nigeria and Pakistan.
  3. Sensitivity analysis: Identify key cost and epidemiological inputs that have the greatest influence on total cost and cost-effectiveness.
  4. ACS in other low- and middle-income countries (LMICs): Use the results of (1) to (3) to model the affordability and cost-effectiveness of ACS in other priority low- and middle-income countries.

We will assemble cost data from hospitals that participated in the ACTION-I Trial, and combine this with effectiveness estimates reported in the trial.

This study will provide important evidence to support implementation of ACS in LMICs, including: updating related WHO recommendations, including ACS in health benefits packages, informing policy-makers about cost-effectiveness and affordability of ACS, and facilitating efficient implementation by identifying key cost drivers.


  • Ethics approval – February 2021
  • Local site approvals – March 2021
  • Interviews and data assembly – April-June 2021
  • Data analysis – June 2021
  • Review model and update analysis – July 2021
  • Report results – August 2021

Contact Details

For any general enquiries relating to this project, please contact:

Associate Professor Joshua Vogel

Principal Research Fellow; Deputy Discipline Head, International Development