Introduction: Women in developing countries have a lifetime excess risk of 552/10,000 of dying in childbirth compared with American women. Access to adequate prenatal and delivery care may avert many of these deaths.
Objective: To model the cost-effectiveness of providing improved obstetric emergency care through enhanced personnel training, pharmacotherapy, and facility upgrades, in a developing country, compared to traditional home birth.
Method: A decision tree was structured to compare the costs and maternal outcomes, employing a public payer perspective, of care provided in the upgraded health center compared with home birth. Model parameters (probabilities and costs) were derived from a review of the published literature, particularly a study upgrading a health center in Ghana. Maternal lives saved was employed as the outcome measure and costs included the expense for upgrading the health center, adding an operating theatre, personnel training, drugs, and necessary Caesarian sections. A hypothetical cohort of 1000 women was followed during birth and the course of any postpartum complications.
Results: Compared to home birth, employing emergency obstetric care in an upgraded health center cost $660 per maternal life saved. Varying the patient capacity of the center and the case-fatality rate in sensitivity analyses resulted in a range of incremental cost per maternal life saved between US$460 and US$2800.
Conclusion: These results suggest that enhancing care before and during childbirth may reduce the risk of death during childbirth. Before undertaking such enhancements, policymakers and administrators must decide whether this risk reduction merits the expenditure of scare resources.
Learning Objectives: At the conclusion of the session the participant in this session will be able to : 1. Identify important cost items for enhancing maternal care in childbirth in developing countries 2. Apply the estimated costs for upgrading a health center in a decision tree analysis to estimate the outcome of maternal lives saved
Keywords: Maternal Care, Cost Issues
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.