The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana
To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. A program integrating leadership development, clinical skills and quality improvement trai...
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| creator | Bogdewic, Stephanie Ramaswamy, Rohit Goodman, David M Srofenyoh, Emmanuel K Ucer, Sebnem Owen, Medge D |
| description | To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana.
Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.
A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses.
Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo.
From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths.
An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training. |
| doi_str_mv | 10.1371/journal.pone.0242170 |
| format | Article |
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Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.
A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses.
Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo.
From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths.
An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0242170</identifier><identifier>PMID: 33186395</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anesthesiology ; Babies ; Biology and Life Sciences ; Births ; Childbirth & labor ; Cost analysis ; Cost-Benefit Analysis ; Earth Sciences ; Economic aspects ; Fatalities ; Ghana ; Health Plan Implementation - economics ; Health services ; Humans ; Infant ; Infant mortality ; Infant Mortality - trends ; Initiatives ; Intervention ; Leadership ; Maternal health services ; Medical economics ; Medicine and Health Sciences ; Mortality ; Neonates ; Newborn babies ; Obstetrical research ; Obstetrics ; Parameter sensitivity ; People and Places ; Prevention ; Professional development ; Public health ; Quality control ; Quality Improvement - economics ; Quality management ; Quality-Adjusted Life Years ; Sensitivity analysis ; Social Sciences ; Stillbirth ; Strengthening ; System effectiveness ; Tertiary Care Centers - economics ; Tertiary Care Centers - standards ; Tertiary Care Centers - statistics & numerical data ; Training</subject><ispartof>PloS one, 2020-11, Vol.15 (11), p.e0242170-e0242170</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Bogdewic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Bogdewic et al 2020 Bogdewic et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-55e3cfcaa765a1eb06efdca40ece69d8a885f08170cb43539ba822b2d894e99d3</citedby><cites>FETCH-LOGICAL-c692t-55e3cfcaa765a1eb06efdca40ece69d8a885f08170cb43539ba822b2d894e99d3</cites><orcidid>0000-0003-3279-7926 ; 0000-0003-3410-4441 ; 0000-0002-0180-4911</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665827/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665827/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33186395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Doherty, Tanya</contributor><creatorcontrib>Bogdewic, Stephanie</creatorcontrib><creatorcontrib>Ramaswamy, Rohit</creatorcontrib><creatorcontrib>Goodman, David M</creatorcontrib><creatorcontrib>Srofenyoh, Emmanuel K</creatorcontrib><creatorcontrib>Ucer, Sebnem</creatorcontrib><creatorcontrib>Owen, Medge D</creatorcontrib><title>The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana.
Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.
A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses.
Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo.
From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths.
An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.</description><subject>Anesthesiology</subject><subject>Babies</subject><subject>Biology and Life Sciences</subject><subject>Births</subject><subject>Childbirth & labor</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Earth Sciences</subject><subject>Economic aspects</subject><subject>Fatalities</subject><subject>Ghana</subject><subject>Health Plan Implementation - economics</subject><subject>Health services</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant mortality</subject><subject>Infant Mortality - trends</subject><subject>Initiatives</subject><subject>Intervention</subject><subject>Leadership</subject><subject>Maternal health services</subject><subject>Medical economics</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Obstetrical research</subject><subject>Obstetrics</subject><subject>Parameter sensitivity</subject><subject>People and Places</subject><subject>Prevention</subject><subject>Professional development</subject><subject>Public health</subject><subject>Quality control</subject><subject>Quality Improvement - economics</subject><subject>Quality management</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Social Sciences</subject><subject>Stillbirth</subject><subject>Strengthening</subject><subject>System effectiveness</subject><subject>Tertiary Care Centers - economics</subject><subject>Tertiary Care Centers - standards</subject><subject>Tertiary Care Centers - statistics & numerical data</subject><subject>Training</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1GL1DAUhYso7jr6D0QLgujDjGmSpsmLsCy6Diws6OprSNObmQxt003Sxf33ZpzuMpV9kEJTbr9z0nuam2WvC7QqSFV82rnR96pdDa6HFcIUFxV6kp0WguAlw4g8PXo-yV6EsEOoJJyx59kJIQVnRJSn2XC9hVy7EJdgDOhob6GHEHJncpUP3m286vLocg_NqCG3ffRqUD6OXa76Ju_B9SqqNu-cT4uNdwlJSg8GvE_1rQuD3QOpfLFVvXqZPTOqDfBqWhfZz69frs-_LS-vLtbnZ5dLzQSOy7IEoo1WqmKlKqBGDEyjFUWggYmGK85Lg3jqWdeUlETUimNc44YLCkI0ZJG9PfgOrQtyCitITBkiFSnTfZGtD0Tj1E4O3nbK30mnrPxbcH4jU6NWtyBRLajQmBrW1FSwilPNBTK8xFgYrlny-jztNtYdNBr2ObUz0_mb3m7lxt3KirGS4yoZfJgMvLsZIUTZ2aChbVWKeDx8d8VowcuEvvsHfby7idqo1IDtjUv76r2pPEs-FPOqIolaPUKlq4HO6nSyjE31meDjTJCYCL_jRo0hyPWP7__PXv2as--P2C2oNm6Da8doXR_mID2A2rsQ0jl7CLlAcj8Y92nI_WDIaTCS7M3xD3oQ3U8C-QPzNQlB</recordid><startdate>20201113</startdate><enddate>20201113</enddate><creator>Bogdewic, Stephanie</creator><creator>Ramaswamy, Rohit</creator><creator>Goodman, David M</creator><creator>Srofenyoh, Emmanuel K</creator><creator>Ucer, Sebnem</creator><creator>Owen, Medge D</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-3279-7926</orcidid><orcidid>https://orcid.org/0000-0003-3410-4441</orcidid><orcidid>https://orcid.org/0000-0002-0180-4911</orcidid></search><sort><creationdate>20201113</creationdate><title>The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana</title><author>Bogdewic, Stephanie ; Ramaswamy, Rohit ; Goodman, David M ; Srofenyoh, Emmanuel K ; Ucer, Sebnem ; Owen, Medge D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-55e3cfcaa765a1eb06efdca40ece69d8a885f08170cb43539ba822b2d894e99d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Babies</topic><topic>Biology and Life Sciences</topic><topic>Births</topic><topic>Childbirth & labor</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Earth Sciences</topic><topic>Economic aspects</topic><topic>Fatalities</topic><topic>Ghana</topic><topic>Health Plan Implementation - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bogdewic, Stephanie</au><au>Ramaswamy, Rohit</au><au>Goodman, David M</au><au>Srofenyoh, Emmanuel K</au><au>Ucer, Sebnem</au><au>Owen, Medge D</au><au>Doherty, Tanya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-11-13</date><risdate>2020</risdate><volume>15</volume><issue>11</issue><spage>e0242170</spage><epage>e0242170</epage><pages>e0242170-e0242170</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana.
Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.
A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses.
Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo.
From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths.
An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33186395</pmid><doi>10.1371/journal.pone.0242170</doi><tpages>e0242170</tpages><orcidid>https://orcid.org/0000-0003-3279-7926</orcidid><orcidid>https://orcid.org/0000-0003-3410-4441</orcidid><orcidid>https://orcid.org/0000-0002-0180-4911</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anesthesiology Babies Biology and Life Sciences Births Childbirth & labor Cost analysis Cost-Benefit Analysis Earth Sciences Economic aspects Fatalities Ghana Health Plan Implementation - economics Health services Humans Infant Infant mortality Infant Mortality - trends Initiatives Intervention Leadership Maternal health services Medical economics Medicine and Health Sciences Mortality Neonates Newborn babies Obstetrical research Obstetrics Parameter sensitivity People and Places Prevention Professional development Public health Quality control Quality Improvement - economics Quality management Quality-Adjusted Life Years Sensitivity analysis Social Sciences Stillbirth Strengthening System effectiveness Tertiary Care Centers - economics Tertiary Care Centers - standards Tertiary Care Centers - statistics & numerical data Training |
| title | The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana |
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