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The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.

Publication ,  Journal Article
Goodman, DM; Ramaswamy, R; Jeuland, M; Srofenyoh, EK; Engmann, CM; Olufolabi, AJ; Owen, MD
Published in: PLoS One
2017

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.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

7

Start / End Page

e0180929

Location

United States

Related Subject Headings

  • Tertiary Care Centers
  • Stillbirth
  • Risk Factors
  • Retrospective Studies
  • Quality Improvement
  • Program Evaluation
  • Pregnancy
  • Monte Carlo Method
  • Maternal Mortality
  • Labor, Obstetric
 

Citation

APA
Chicago
ICMJE
MLA
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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. https://doi.org/10.1371/journal.pone.0180929
Goodman, David M., Rohit Ramaswamy, Marc Jeuland, Emmanuel K. Srofenyoh, Cyril M. Engmann, Adeyemi J. Olufolabi, and Medge D. Owen. “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, no. 7 (2017): e0180929. https://doi.org/10.1371/journal.pone.0180929.
Goodman DM, Ramaswamy R, Jeuland M, Srofenyoh EK, Engmann CM, Olufolabi AJ, et al. The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana. PLoS One. 2017;12(7):e0180929.
Goodman, David M., et al. “The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.PLoS One, vol. 12, no. 7, 2017, p. e0180929. Pubmed, doi:10.1371/journal.pone.0180929.
Goodman DM, Ramaswamy R, Jeuland M, Srofenyoh EK, Engmann CM, Olufolabi AJ, Owen MD. The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana. PLoS One. 2017;12(7):e0180929.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

7

Start / End Page

e0180929

Location

United States

Related Subject Headings

  • Tertiary Care Centers
  • Stillbirth
  • Risk Factors
  • Retrospective Studies
  • Quality Improvement
  • Program Evaluation
  • Pregnancy
  • Monte Carlo Method
  • Maternal Mortality
  • Labor, Obstetric