179198 Cost impact of modernizing delivery care in the Republic of Georgia: Assessment of delivery costs at two hospitals in Imereti region before (2004) and after (2007) training health care providers and implementing effective perinatal care practices

Tuesday, October 28, 2008

Mariella C. Tefft, BS, BSN, RN, MS , Statistical Consultant to Healthy Women in Georgia Program, JSI R&T Inc., Tbilisi, Georgia
Nino Berdzuli, MD, MPH , Senior Technical Advisor for Maternal Health, John Snow, Inc., Arlington, VA
Renée K. Fiorentino, BS, MPH , Monitoring, Evaluation and Research Program Associate, EngenderHealth, New York, NY
Julie M. Langsdale, BS, MPH , Consultant to Healthy Women in Georgia Program, JSI R&T Inc., Spring Mills, PA
Nino Lomia, MD, MPH , Monitoring and Evaluation Advisor of Healthy Women in Georgia Program, JSI R&T Inc., Tbilisi, Georgia
Georgia still struggles to deliver quality health care to its people, particularly mothers and infants (2005 official statistics: MMR 23.4, IMR 18.1). In early 2006, using WHO guidelines, JSI's Healthy Women in Georgia Program (USAID funded) trained providers at two hospitals in Imereti in effective perinatal care (EPC) practices, which were then implemented. Purpose: To estimate impact of utilizing EPC practices for a year on total costs per delivery. Methods: 100 delivery records were randomly selected from each hospital (Kutaisi and Zestaponi), for each time period: January-June, 2004 (before EPC) and January-June, 2007 (after EPC), for total of 400 records. Information on drugs, supplies, tests, demographics, and care practices was abstracted for each delivery. Total costs of drugs, supplies, and tests per delivery were calculated using 2007 prices. Analysis: SAS GLM procedure was used to model effects of EPC, hospital, and delivery type (vaginal vs. c-section) on total costs of drugs, supplies, and tests per delivery. Results: Adjusted for effects of hospital and delivery type, the average overall delivery cost after EPC ($27.17) was 13.4% lower than before ($31.38) (p<0.0001). This moderate cost savings was due to large reductions in maternal drug costs (59%) and supply costs (77%) that were offset by a 78% increase in maternal test costs for vaginal deliveries (p<0.0001). Costly HIV testing was added to postpartum care in 2007; no postpartum HIV testing occurred in 2004. Implications: Provides evidence to Georgian policymakers and businessmen that investments in training and modernizing delivery care can be cost efficient.

Learning Objectives:
1. Describe the method used to select delivery records for this delivery cost assessment. 2. Identify the three cost categories whose totals were calculated separately for each delivery and were used as outcomes in this delivery cost assessment. 3. List the three independent effects that were used to estimate the average overall delivery cost and identify which of these was the focus of this delivery cost assessment. 4. Identify which cost categories experienced reductions and increases after effective perinatal care training and implementation. 5. Articulate the reason why the overall delivery cost savings was moderate after effective perinatal care training and implementation.

Keywords: International MCH, Cost Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I performed all of the statistical analyses of the data that was collected according to my study design.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.