Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar : a cost-effectiveness analysis
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
CONTEXT: There is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems that reduce preventable maternal and neonatal deaths are scarce.
SETTING: We aimed to determine the cost-effectiveness of a non-governmental organisation (NGO)-run inter-facility referral system for emergency obstetrical and neonatal care in rural Southern Madagascar by analysing the characteristics of cases referred through the intervention as well as its costs.
DESIGN: We used secondary NGO data, drawn from an NGO's monitoring and financial administration database, including medical and financial records.
OUTCOME MEASURES: We performed a descriptive and a cost-effectiveness analysis, including a one-way deterministic sensitivity analysis.
RESULTS: 1172 cases were referred over a period of 4 years. The most common referral reasons were obstructed labour, ineffective labour and eclampsia. In total, 48 neonates were referred through the referral system over the study period. Estimated cost per referral was US$336 and the incremental cost-effectiveness ratio (ICER) was US$70 per additional life-year saved (undiscounted, discounted US$137). The sensitivity analysis showed that the intervention was cost-effective for all scenarios with the lowest ICER at US$99 and the highest ICER at US$205 per additional life-year saved. When extrapolated to the population living in the study area, the investment costs of the programme were US$0.13 per person and annual running costs US$0.06 per person.
CONCLUSIONS: In our study, the inter-facility referral system was a very cost-effective intervention. Our findings may inform policies, decision-making and implementation strategies for emergency obstetrical and neonatal care referral systems in similar resource-constrained settings.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
|---|---|
| Enthalten in: |
BMJ open - 14(2024), 4 vom: 03. Apr., Seite e081482 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Franke, Mara Anna [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
ACCIDENT & EMERGENCY MEDICINE |
|---|
| Anmerkungen: |
Date Completed 05.04.2024 Date Revised 05.04.2024 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1136/bmjopen-2023-081482 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM370591011 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM370591011 | ||
| 003 | DE-627 | ||
| 005 | 20240405234144.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240404s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/bmjopen-2023-081482 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1366.xml |
| 035 | |a (DE-627)NLM370591011 | ||
| 035 | |a (NLM)38569673 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Franke, Mara Anna |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar |b a cost-effectiveness analysis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 05.04.2024 | ||
| 500 | |a Date Revised 05.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a CONTEXT: There is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems that reduce preventable maternal and neonatal deaths are scarce | ||
| 520 | |a SETTING: We aimed to determine the cost-effectiveness of a non-governmental organisation (NGO)-run inter-facility referral system for emergency obstetrical and neonatal care in rural Southern Madagascar by analysing the characteristics of cases referred through the intervention as well as its costs | ||
| 520 | |a DESIGN: We used secondary NGO data, drawn from an NGO's monitoring and financial administration database, including medical and financial records | ||
| 520 | |a OUTCOME MEASURES: We performed a descriptive and a cost-effectiveness analysis, including a one-way deterministic sensitivity analysis | ||
| 520 | |a RESULTS: 1172 cases were referred over a period of 4 years. The most common referral reasons were obstructed labour, ineffective labour and eclampsia. In total, 48 neonates were referred through the referral system over the study period. Estimated cost per referral was US$336 and the incremental cost-effectiveness ratio (ICER) was US$70 per additional life-year saved (undiscounted, discounted US$137). The sensitivity analysis showed that the intervention was cost-effective for all scenarios with the lowest ICER at US$99 and the highest ICER at US$205 per additional life-year saved. When extrapolated to the population living in the study area, the investment costs of the programme were US$0.13 per person and annual running costs US$0.06 per person | ||
| 520 | |a CONCLUSIONS: In our study, the inter-facility referral system was a very cost-effective intervention. Our findings may inform policies, decision-making and implementation strategies for emergency obstetrical and neonatal care referral systems in similar resource-constrained settings | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ACCIDENT & EMERGENCY MEDICINE | |
| 650 | 4 | |a Health economics | |
| 650 | 4 | |a NEONATOLOGY | |
| 650 | 4 | |a OBSTETRICS | |
| 700 | 1 | |a Nordmann, Kim |e verfasserin |4 aut | |
| 700 | 1 | |a Frühauf, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Ranaivoson, Rinja Mitolotra |e verfasserin |4 aut | |
| 700 | 1 | |a Rebaliha, Mahery |e verfasserin |4 aut | |
| 700 | 1 | |a Rapanjato, Zavaniarivo |e verfasserin |4 aut | |
| 700 | 1 | |a Bärnighausen, Till |e verfasserin |4 aut | |
| 700 | 1 | |a Muller, Nadine |e verfasserin |4 aut | |
| 700 | 1 | |a Knauss, Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Emmrich, Julius Valentin |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t BMJ open |d 2011 |g 14(2024), 4 vom: 03. Apr., Seite e081482 |w (DE-627)NLM215724372 |x 2044-6055 |7 nnns |
| 773 | 1 | 8 | |g volume:14 |g year:2024 |g number:4 |g day:03 |g month:04 |g pages:e081482 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1136/bmjopen-2023-081482 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 14 |j 2024 |e 4 |b 03 |c 04 |h e081482 | ||