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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

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  • David M Goodman
  • Rohit Ramaswamy
  • Marc Jeuland
  • Emmanuel K Srofenyoh
  • Cyril M Engmann
  • Adeyemi J Olufolabi
  • Medge D Owen

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.

Suggested Citation

  • David M Goodman & Rohit Ramaswamy & Marc Jeuland & Emmanuel K Srofenyoh & Cyril M Engmann & Adeyemi J Olufolabi & Medge D Owen, 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, Public Library of Science, vol. 12(7), pages 1-19, July.
    • Handle: RePEc:plo:pone00:0180929
    DOI: 10.1371/journal.pone.0180929
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    Cited by:

    1. Stephanie Bogdewic & Rohit Ramaswamy & David M Goodman & Emmanuel K Srofenyoh & Sebnem Ucer & Medge D Owen, 2020. "The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-18, November.
    2. Osseo-Asare, Abena Dove, 2023. "“Don't use herbs in labor!”: Plants, pharmaceuticals, and the unmaking of traditional birth attendants in Ghana, 1970–2000," Social Science & Medicine, Elsevier, vol. 329(C).
    3. So O'Neil & Divya Vohra & Matthew Spitzer & Shveta Kalyanwala & Dana Rotz, "undated". "Maternal Health Care Quality and Outcomes Under the Utkrisht Impact Bond: Midline Findings and Insights," Mathematica Policy Research Reports 159825ed8e034ce396cd6422c, Mathematica Policy Research.

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