Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries.
Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries.
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DOI：
10.1186/s12889-021-10750-8
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发表时间：
2021-05-20
影响因子：
4.5
通讯作者：
Nathan RO
中科院分区：
文献类型：
--
作者：
Bresnahan BW;Vodicka E;Babigumira JB;Malik AM;Yego F;Lokangaka A;Chitah BM;Bauer Z;Chavez H;Moore JL;Garrison LP;Swanson JO;Swanson D;McClure EM;Goldenberg RL;Esamai F;Garces AL;Chomba E;Saleem S;Tshefu A;Bose CL;Bauserman M;Carlo W;Bucher S;Liechty EA;Nathan RO
多年来，改善产妇保健一直是国际卫生机构的主要目标，目的是减少孕产妇和儿童死亡，改善获得产前护理服务的机会，特别是在低收入和中等收入国家。与成本影响和经济效率相比，从临床效果的角度来看，具有这些目标的卫生干预措施受到了更多的关注。我们收集了有关资源使用和成本的数据，作为评估常规产前筛查超声(US)使用情况的大型多国研究的一部分，目的是考虑对经济效益的影响。我们总体上评估了孕妇的典型产前门诊和基于医院(设施)的护理，对参与大型孕产妇健康登记和五个LMIC临床试验的妇女进行了选择性的并发症相关数据收集。我们从设施/卫生系统的角度估算了门诊和住院服务的平均成本。我们将所有国家/地区的成本估算折算为2015美元。我们比较了不同国家的ANC就诊、分娩、高危妊娠和并发症的平均成本，并进行了敏感性分析。我们的研究包括代表不同地区的五个国家的网站。总体而言，不同国家之间的个人ANC和与分娩相关的医疗保健使用的相对成本是一致的，通常与特定国家的收入水平相对应。根据有美国和没有美国的平均就诊计数，ANC在不同国家之间的每个患者的门诊费用估计在15到30美元之间。据估计，美国的产前筛查费用比非美国的要高。与高危妊娠相关的费用受剖宫产率(平均每人分娩费用估计范围：25-65美元)的影响。尽管各国在基础设施和卫生系统能力方面有很大差异，但在资源分配、提供地点和国家一级的挑战方面存在相似之处。总体而言，没有明确的迹象表明，增加产前筛查美国将导致重大成本节约或重大成本增加。然而，美国产前筛查的培训和维护成本会更高。鉴于LMIC缺乏临床有效性证据和更大的资源限制，在这些环境下引入产前筛查US不太可能在经济上有效--无论是在需求侧(即患者)还是在供应侧(即医疗保健提供者)。试用号：NCT01990625(首次在https://clinicaltrials.gov).上发布：2013年11月21日网上版载有补充材料，可在10.1186/s12889-021-10750-8查阅。
Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25–65 USD). Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov). The online version contains supplementary material available at 10.1186/s12889-021-10750-8.
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影响因子：
1.3
作者：
Nathan R;Swanson JO;Marks W;Goldsmith N;Vance C;Sserwanga NB;Swanson D;McClure EM;Franklin H;Mirza W;Mwenechanya M;Muyodi D;Figuero L;Bolamba VL;Goldenberg RL;Pineda IS
通讯作者：
Pineda IS
DOI：
10.1016/j.ijgo.2008.12.022
发表时间：
2009-04-01
影响因子：
3.8
作者：
Burchett, Helen E.;Mayhew, Susannah H.
通讯作者：
Mayhew, Susannah H.
DOI：
10.9745/ghsp-d-16-00156
发表时间：
2016-12-23
期刊：
Global health, science and practice
影响因子：
--
作者：
Swanson JO;Plotner D;Franklin HL;Swanson DL;Lokomba Bolamba V;Lokangaka A;Sayury Pineda I;Figueroa L;Garces A;Muyodi D;Esamai F;Kanaiza N;Mirza W;Naqvi F;Saleem S;Mwenechanya M;Chiwila M;Hamsumonde D;McClure EM;Goldenberg RL;Nathan RO
通讯作者：
Nathan RO
影响因子：
4
作者：
Sion, Melanie;Rajan, Dheepa;Cherian, Meena
通讯作者：
Cherian, Meena
影响因子：
1.3
作者：
Kawooya, Michael G.;Nathan, Robert O.;Ddungu-Matovu, Peter
通讯作者：
Ddungu-Matovu, Peter