Abstract:
Background: 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.
Methods: 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.
Results: 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).Conclusions: 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)