Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis

Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis

ContextThere 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.SettingWe aimed to determin...

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Bibliographic Details
Published in:BMJ open Vol. 14; no. 4; p. e081482
Main Authors: Franke, Mara Anna, Nordmann, Kim, Frühauf, Anna, Ranaivoson, Rinja Mitolotra, Rebaliha, Mahery, Rapanjato, Zavaniarivo, Bärnighausen, Till, Muller, Nadine, Knauss, Samuel, Emmrich, Julius Valentin
Format: Journal Article
Language:English
Published: England British Medical Journal Publishing Group 03-04-2024
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Original research
Subjects:
ACCIDENT & EMERGENCY MEDICINE
Automobiles
Catheters
Childbirth & labor
Cost analysis
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Emergency medical care
Fatalities
Female
Global Health
Health economics
Health facilities
Hospitals
Humans
Infant mortality
Infant, Newborn
Intervention
Labor, Obstetric
Madagascar
Maternal & child health
Maternal mortality
Medical equipment
Medical records
Medical referrals
Medical research
Neonatal care
NEONATOLOGY
Newborn babies
OBSTETRICS
Patients
Pregnancy
Rural areas
Vehicles
Madagascar
United States > US
Africa
Health economics
OBSTETRICS
ACCIDENT & EMERGENCY MEDICINE
NEONATOLOGY
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Summary:ContextThere 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.SettingWe 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.DesignWe used secondary NGO data, drawn from an NGO’s monitoring and financial administration database, including medical and financial records.Outcome measuresWe performed a descriptive and a cost-effectiveness analysis, including a one-way deterministic sensitivity analysis.Results1172 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.ConclusionsIn 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.
Bibliography:Original research
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SourceType-Scholarly Journals-1
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SK and JVE are joint senior authors.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2023-081482