In Reply We thank Dr Klar for her comments. The presentation of cost-effectiveness in our article1 follows the concise norm for similar trial articles. The account in the eAppendix provides the essential details of the cost-effectiveness analysis. Further analysis of costs, including sensitivity analysis, will be submitted for publication to add to the growing evidence base for women’s groups interventions.2 We would like to correct an important misunderstanding of our evidence—we show that the intervention is cost-effective, not that it saves money. This claim of cost-effectiveness relates to World Health Organization recommendations to compare cost-effectiveness ratios with local gross domestic product per capita.3 Health systems–strengthening initiatives were conducted in both intervention and control arms of the trial, and so their costs had no bearing on our cost-effectiveness calculation.
Fottrell E, Skordis-Worrall J, Houweling TAJ. Reducing Neonatal Mortality—Reply. JAMA Pediatr. 2014;168(3):292–293. doi:10.1001/jamapediatrics.2013.4873