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The Cost Effectiveness of a Quality Improvement Program to Reduce Maternal Mortality in a West African Regional Hospital
Abstract Number: SA-38
Abstract Type: Original Research
Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal mortality and stillbirth in Accra, Ghana.
Background Few studies have examined the cost effectiveness of interventions to improve comprehensive emergency obstetric care (CEmOC) in low-resource settings. Providing access to high-quality CEmOC is a significant barrier to achieving Sustainable Development Goal 3 to reduce maternal mortality to less than 70 deaths per 100,000 live births. From 2007-2011 Kybele, Inc partnered with the Ghana Health Service to improve care at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana by employing quality improvement methodologies with a focus on system, personnel, and communication. During the intervention 39,234 deliveries occurred and significant increases were observed in the volume and acuity of patients. Previous reports have shown that the intervention successfully prevented maternal deaths, but it is imperative that this success be scrutinized for cost-effectiveness.
Methods Quasi-experimental, cost –effectiveness evaluation. Data from the Kybele-Ghana Health Service Partnership were linked with the program budget including the opportunity cost of volunteered professional time. Disability-adjusted life-years (DALYs) were calculated for maternal deaths and stillbirths. Cost-effectiveness was calculated based on various models for estimating the number of maternal deaths prevented.
Main outcome measure Incremental cost-effectiveness ratio (ICER), which represents the cost per DALY averted by the intervention for each modeled scenario.
Results The program cost $2,723,700 with volunteered professional time accounting for $1,209,400 (44%) of the budget. Based on program estimates 43 maternal deaths (range 39-239) and 129 intrapartum stillbirths were prevented leading to an ICER of $250 USD (range $112-$256). This value is well below the GDP-based highly cost-effective threshold of $2917 USD. Factors that were considered in the modeling were the annual rate of change for maternal mortality in Ghana; changing volume, incidence, and case-fatality rates at Ridge Regional Hospital; and local case-fatality rates at comparable institutions. In each scenario modeled, the program remained highly cost-effective.
Conclusion Quality improvement focused on systems-level improvement of comprehensive emergency obstetrical care can be a highly cost effective approach to reduce maternal and fetal mortality.