Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0180929
Title: The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana
Authors: Goodman D.M.
Ramaswamy R.
Jeuland M. 
Srofenyoh E.K.
Engmann C.M.
Olufolabi A.J.
Owen M.D.
Keywords: adolescent
adult
Article
calculation
disability
female
fetus
fetus mortality
Ghana
human
hypertension
information processing
interpersonal communication
maternal mortality
Monte Carlo method
obstetric hemorrhage
personnel
program cost effectiveness
quality adjusted life year
quasi experimental study
retrospective study
sensitivity analysis
stillbirth
tertiary care center
total quality management
cost benefit analysis
economics
fetus mortality
Hemorrhage
labor
maternal hypertension
maternal mortality
mortality
pathology
pregnancy
program evaluation
risk factor
tertiary care center
total quality management
Adult
Cost-Benefit Analysis
Female
Fetal Mortality
Ghana
Hemorrhage
Humans
Hypertension, Pregnancy-Induced
Labor, Obstetric
Maternal Mortality
Monte Carlo Method
Pregnancy
Program Evaluation
Quality Improvement
Retrospective Studies
Risk Factors
Stillbirth
Tertiary Care Centers
Issue Date: 2017
Citation: Goodman D.M., Ramaswamy R., Jeuland M., Srofenyoh E.K., Engmann C.M., Olufolabi A.J., Owen M.D. (2017). The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana. PLoS ONE 12 (7) : e0180929. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0180929
Rights: Attribution 4.0 International
Abstract: Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Main outcome measure Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual. Results From 2007–2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of $158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from $97-$218. Conclusion QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to encourage fiscal responsibility in the pursuit of improved maternal and child health. © 2017 Goodman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161183
ISSN: 19326203
DOI: 10.1371/journal.pone.0180929
Rights: Attribution 4.0 International
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