Volume 74, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were $5.21/episode averted, $0.62/diarrhea-day averted, and $1,252/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been $11/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 diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.


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  • Received : 27 Jul 2005
  • Accepted : 02 Jan 2006

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