Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya.
Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya.
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DOI：
10.1136/bmjgh-2020-002452
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发表时间：
2021-03
影响因子：
8.1
通讯作者：
Barasa E
中科院分区：
文献类型：
--
作者：
Kumar MB;Madan JJ;Auguste P;Taegtmeyer M;Otiso L;Ochieng CB;Muturi N;Mgamb E;Barasa E
改善孕产妇和婴儿健康结果是肯尼亚的政策重点。实现这些结果取决于妊娠的早期识别和初级医疗保健的质量。事实证明，质量改进干预措施有助于增加社区卫生工作者对孕妇的识别、转诊和随访。在这项研究中，我们评估了在社区层面利用质量改进来降低肯尼亚孕产妇和婴儿死亡率的成本效益。我们使用决策树模型并从卫生系统的角度评估了与产前和分娩母亲的护理治疗标准相比质量改进的成本效益。我们使用过程（妊娠早期的产前启动和熟练分娩）和健康结果（避免孕产妇和婴儿死亡，以及残疾调整生命年（DALY））作为我们的有效性衡量标准和实际实施成本（仅贴现成本）。我们进行了确定性和概率敏感性分析。我们发现，与标准社区医疗保健相比，社区质量改善干预措施更具成本效益，在确定性分析下，每个 DALY 的增量成本可节省 249 美元，在使用标准阈值的概率敏感性分析下，成本效益的可能性为 76%。确定性估计，每次增加熟练分娩的增量成本为 10 美元，每次额外的早期产前护理介绍为 155 美元，每项避免孕产妇死亡为 5654 美元，每项避免婴儿死亡为 37,536 美元（2017 年美元）。该分析表明，由于产前护理的采用率和熟练分娩技术的提高，与肯尼亚的标准社区医疗保健相比，社区质量改善干预措施具有成本效益。质量改进干预措施可能是一项良好的投资，也可能在其他卫生领域产生效益。
Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya. We estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses. We found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars). This analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.
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影响因子：
4.5
作者：
Horwood C;Butler L;Barker P;Phakathi S;Haskins L;Grant M;Mntambo N;Rollins N
通讯作者：
Rollins N
影响因子：
6.1
作者：
Chen, Ariel;Jacobsen, Kathryn H.;Cantor, Scott B.
通讯作者：
Cantor, Scott B.
影响因子：
3.3
作者：
Cofie, Leslie E.;Barrington, Clare;Barker, Pierre M.
通讯作者：
Barker, Pierre M.
DOI：
10.1016/s2214-109x(18)30386-3
发表时间：
2018-11
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kruk ME;Gage AD;Arsenault C;Jordan K;Leslie HH;Roder-DeWan S;Adeyi O;Barker P;Daelmans B;Doubova SV;English M;García-Elorrio E;Guanais F;Gureje O;Hirschhorn LR;Jiang L;Kelley E;Lemango ET;Liljestrand J;Malata A;Marchant T;Matsoso MP;Meara JG;Mohanan M;Ndiaye Y;Norheim OF;Reddy KS;Rowe AK;Salomon JA;Thapa G;Twum-Danso NAY;Pate M
通讯作者：
Pate M
影响因子：
7.2
作者：
Khowaja, Asif R.;Mitton, Craig;von Dadelszen, Peter
通讯作者：
von Dadelszen, Peter