The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi.
child health
health economics
maternal health
public health
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
27
12
2019
revised:
13
03
2020
accepted:
15
04
2020
entrez:
24
5
2020
pubmed:
24
5
2020
medline:
25
6
2021
Statut:
ppublish
Résumé
Results-based financing (RBF) is being promoted to increase coverage and quality of maternal and perinatal healthcare in sub-Saharan Africa (SSA) countries. Evidence on the cost-effectiveness of RBF is limited. We assessed the cost-effectiveness within the context of an RBF intervention, including performance-based financing and conditional cash transfers, in rural Malawi. We used a decision tree model to estimate expected costs and effects of RBF compared with status quo care during single pregnancy episodes. RBF effects on maternal case fatality rates were modelled based on data from a maternal and perinatal programme evaluation in Zambia and Uganda. We obtained complementary epidemiological information from the published literature. Service utilisation rates for normal and complicated deliveries and associated costs of care were based on the RBF intervention in Malawi. Costs were estimated from a societal perspective. We estimated incremental cost-effectiveness ratios per disability adjusted life year (DALY) averted, death averted and life-year gained (LYG) and conducted sensitivity analyses to how robust results were to variations in key model parameters. Relative to status quo, RBF implied incremental costs of US$1122, US$26 220 and US$987 per additional DALY averted, death averted and LYG, respectively. The share of non-RBF facilities that provide quality care, life expectancy of mothers at time of delivery and the share of births in non-RBF facilities strongly influenced cost-effectiveness values. At a willingness to pay of US$1485 (3 times Malawi gross domestic product per capita) per DALY averted, RBF has a 77% probability of being cost-effective. At high thresholds of wiliness-to-pay, RBF is a cost-effective intervention to improve quality of maternal and perinatal healthcare and outcomes, compared with the non-RBF based approach. More RBF cost-effectiveness analyses are needed in the SSA region to complement the few published studies and narrow the uncertainties surrounding cost-effectiveness estimates.
Identifiants
pubmed: 32444363
pii: bmjgh-2019-002260
doi: 10.1136/bmjgh-2019-002260
pmc: PMC7247376
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
BMJ. 2014 Jan 24;348:f7450
pubmed: 24464277
Global Health. 2019 Jan 15;15(1):6
pubmed: 30646933
Health Econ Rev. 2016 Dec;6(1):30
pubmed: 27472942
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
Soc Sci Med. 2018 Jul;208:1-8
pubmed: 29751178
BMC Public Health. 2016 Apr 14;16:321
pubmed: 27074711
PLoS One. 2017 Sep 21;12(9):e0182326
pubmed: 28934320
Int J Gynaecol Obstet. 2007 Feb;96(2):139-46
pubmed: 17274999
Int J Gynaecol Obstet. 2008 Apr;101(1):107-11
pubmed: 18291400
Bull World Health Organ. 2000;78(5):593-602
pubmed: 10859853
Lancet Glob Health. 2016 Feb;4(2):e98-e108
pubmed: 26795602
BMC Public Health. 2014 Sep 28;14:1014
pubmed: 25263746
BMC Pregnancy Childbirth. 2013 Apr 15;13:93
pubmed: 23587107
Bull World Health Organ. 1996;74(2):165-71
pubmed: 8706232
Bull World Health Organ. 2016 Dec 1;94(12):925-930
pubmed: 27994285
Trop Med Int Health. 2015 May;20(5):617-626
pubmed: 25656750
BMC Pregnancy Childbirth. 2011 Sep 28;11:65
pubmed: 21955698
BMC Pregnancy Childbirth. 2014 Jul 22;14:243
pubmed: 25052536
BMJ Glob Health. 2018 Oct 15;3(5):e000994
pubmed: 30364408
Lancet. 2005 Mar 5-11;365(9462):891-900
pubmed: 15752534
Trop Med Int Health. 2017 Jan;22(1):92-102
pubmed: 27928874
BJOG. 2000 Jan;107(1):68-74
pubmed: 10645864
BJOG. 2014 Mar;121 Suppl 1:76-88
pubmed: 24641538
Bull World Health Organ. 2017 Jul 1;95(7):491-502
pubmed: 28670014
Health Policy Plan. 2015 Feb;30(1):88-99
pubmed: 24371219
PLoS One. 2011 May 09;6(5):e19674
pubmed: 21573019
Lancet. 2016 Oct 8;388(10053):1545-1602
pubmed: 27733282
Bull World Health Organ. 2015 Feb 1;93(2):118-24
pubmed: 25883405
Lancet. 2011 Apr 16;377(9774):1353-66
pubmed: 21496915
Health Technol Assess. 2009 Jun;13(29):iii, ix-xi, 1-61
pubmed: 19500484
Health Aff (Millwood). 2015 Mar;34(3):406-14
pubmed: 25732490
Lancet. 2011 Apr 23;377(9775):1421-8
pubmed: 21515164
Health Policy Plan. 2014 Jul;29 Suppl 1:i4-11
pubmed: 24173430
Soc Sci Med. 1994 Apr;38(8):1091-110
pubmed: 8042057
BMJ. 1999 Sep 4;319(7210):635-8
pubmed: 10473486
Lancet. 2007 Oct 13;370(9595):1329-37
pubmed: 17933647
Bull World Health Organ. 2018 Nov 1;96(11):760-771
pubmed: 30455531
Int J Health Care Qual Assur. 2013;26(3):250-61
pubmed: 23729128
J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):36-47
pubmed: 24992802
Hum Resour Health. 2009 Apr 16;7:34
pubmed: 19371433
PLoS One. 2014 Apr 21;9(4):e95439
pubmed: 24751600
Pharmacoeconomics. 2007;25(1):3-6
pubmed: 17192114
BMC Health Serv Res. 2013 Sep 29;13:367
pubmed: 24073625
Bull World Health Organ. 2011 Feb 1;89(2):153-6
pubmed: 21346927
Soc Sci Med. 2002 Apr;54(8):1255-66
pubmed: 11989961
Cost Eff Resour Alloc. 2014 Jun 19;12:14
pubmed: 24976793
Eur J Obstet Gynecol Reprod Biol. 1995 Feb;58(2):131-4
pubmed: 7774738
Cost Eff Resour Alloc. 2003 Dec 19;1(1):8
pubmed: 14687420
East Afr Med J. 2003 Mar;80(3):144-9
pubmed: 12762430
Lancet. 2013 May 18;381(9879):1747-55
pubmed: 23683641
Bull World Health Organ. 2014 Aug 1;92(8):605-12
pubmed: 25177075
PLoS One. 2011;6(6):e20776
pubmed: 21677788
PLoS One. 2015 Apr 15;10(4):e0123968
pubmed: 25875252
BMC Health Serv Res. 2014 Apr 22;14:180
pubmed: 24751213
J Health Popul Nutr. 2011 Oct;29(5):532-40
pubmed: 22106760
Acta Obstet Gynecol Scand. 2012 Sep;91(9):1061-8
pubmed: 22676243
Reprod Health. 2005 Nov 01;2:9
pubmed: 16262901
Pediatrics. 2011 May;127(5):e1176-81
pubmed: 21502223
J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):1-7
pubmed: 24992799
BMC Health Serv Res. 2018 Oct 19;18(1):791
pubmed: 30340491