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. 2020 May;5(5):e002260.
doi: 10.1136/bmjgh-2019-002260.

The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi

Jobiba Chinkhumba  1   2 , Manuela De Allegri  3 , Stephan Brenner  3 , Adamson Muula  4 , Bjarne Robberstad  2
Affiliations

The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi

Jobiba Chinkhumba et al. BMJ Glob Health. 2020 May.

Abstract

Introduction: Results-based financing (RBF) is being promoted to increase coverage and quality of maternal and perinatal healthcare in sub-Saharan Africa (SSA) countries. Evidence on the cost-effectiveness of RBF is limited. We assessed the cost-effectiveness within the context of an RBF intervention, including performance-based financing and conditional cash transfers, in rural Malawi.

Methods: We used a decision tree model to estimate expected costs and effects of RBF compared with status quo care during single pregnancy episodes. RBF effects on maternal case fatality rates were modelled based on data from a maternal and perinatal programme evaluation in Zambia and Uganda. We obtained complementary epidemiological information from the published literature. Service utilisation rates for normal and complicated deliveries and associated costs of care were based on the RBF intervention in Malawi. Costs were estimated from a societal perspective. We estimated incremental cost-effectiveness ratios per disability adjusted life year (DALY) averted, death averted and life-year gained (LYG) and conducted sensitivity analyses to how robust results were to variations in key model parameters.

Results: Relative to status quo, RBF implied incremental costs of US$1122, US$26 220 and US$987 per additional DALY averted, death averted and LYG, respectively. The share of non-RBF facilities that provide quality care, life expectancy of mothers at time of delivery and the share of births in non-RBF facilities strongly influenced cost-effectiveness values. At a willingness to pay of US$1485 (3 times Malawi gross domestic product per capita) per DALY averted, RBF has a 77% probability of being cost-effective.

Conclusions: At high thresholds of wiliness-to-pay, RBF is a cost-effective intervention to improve quality of maternal and perinatal healthcare and outcomes, compared with the non-RBF based approach. More RBF cost-effectiveness analyses are needed in the SSA region to complement the few published studies and narrow the uncertainties surrounding cost-effectiveness estimates.

Keywords: child health; health economics; maternal health; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Pathways of maternal events, demonstrating maternal status after delivery. (A) is linked to perinatal outcomes for live mothers. (B) is linked to perinatal outcomes for dead mothers as shown in (B). (B) Pathways of perinatal events, demonstrating conditional relationships between perinatal outcomes and maternal status after a delivery event. RBF, results-based financing.
Figure 2
Figure 2
One-way sensitivity analysis showing variations in incremental cost-effectiveness ratios per disability adjusted life year averted. RBF, results-based financing.
Figure 3
Figure 3
(A) Incremental cost-effectiveness scatter plot for RBF relative to non-RBF. (B) Cost-effectiveness acceptability curves for RBF compared with non-RBF funding option. RBF, results-based financing.
See this image and copyright information in PMC

References

    1. United Nations Global Strategy for Women’s and Children’s Healths United Nations, Office of the Secretary General, New York. NY 2010;2010.
    1. Blencowe H, Cousens S, Jassir FB, et al. . National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health 2016;4:e98–108. 10.1016/S2214-109X(15)00275-2 - DOI - PubMed
    1. UNICEF Levels & Trends in Child Mortality. Report 2014 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation 2015.
    1. Lawn J, Mongi P, Cousens S. Africa’s newborns–counting them and making them count, 2015. Available: http://www.who.int/pmnch/media/publications/aonsection_I.pdf [Accessed Dec 2016].
    1. WHO Trends in maternal mortality: 1990 to 2015: estimates by who, UNICEF, UNFPA, world bank group and the United nations population division 2015.