Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria

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dc.contributor.authorGomez, Gabriela Ben_ZA
dc.contributor.authorFoster, Nicolaen_ZA
dc.contributor.authorBrals, Daniellaen_ZA
dc.contributor.authorNelissen, Heleen Een_ZA
dc.contributor.authorBolarinwa, Oladimeji Aen_ZA
dc.contributor.authorHendriks, Marleen Een_ZA
dc.contributor.authorBoers, Alexander Cen_ZA
dc.contributor.authorEck, Diederik vanen_ZA
dc.contributor.authorRosendaal, Nicoleen_ZA
dc.contributor.authorAdenusi, Pejuen_ZA
dc.date.accessioned2015-11-11T14:27:49Z
dc.date.available2015-11-11T14:27:49Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI) in rural Nigeria. Methods and FINDINGS: We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER) of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA) based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program’s scale up within the State’s healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted) is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730). Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible interval 21.9-152.3), during one-way sensitivity analyses, and when cost, quality, cost and utilization parameters of the base case scenario were changed. The sustainability of this program’s scale up by the State is dependent on further investments in healthcare. CONCLUSIONS: This study provides evidence that the investment made by the KSHI program in rural Nigeria is likely to have been cost-effective; however, further healthcare investments are needed for this program to be successfully expanded within Kwara State. Policy makers should consider supporting financial initiatives to reduce maternal mortality tackling both supply and demand issues in the access to care.en_ZA
dc.identifier.apacitationGomez, G. B., Foster, N., Brals, D., Nelissen, H. E., Bolarinwa, O. A., Hendriks, M. E., ... Adenusi, P. (2015). Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria. <i>PLoS One</i>, http://hdl.handle.net/11427/14926en_ZA
dc.identifier.chicagocitationGomez, Gabriela B, Nicola Foster, Daniella Brals, Heleen E Nelissen, Oladimeji A Bolarinwa, Marleen E Hendriks, Alexander C Boers, Diederik van Eck, Nicole Rosendaal, and Peju Adenusi "Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/14926en_ZA
dc.identifier.citationGomez, G. B., Foster, N., Brals, D., Nelissen, H. E., Bolarinwa, O. A., Hendriks, M. E., ... & Schultsz, C. (2015). Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria. PloS one, 10(9), e0139048. doi:10.1371/journal.pone.0139048en_ZA
dc.identifier.ris TY - Journal Article AU - Gomez, Gabriela B AU - Foster, Nicola AU - Brals, Daniella AU - Nelissen, Heleen E AU - Bolarinwa, Oladimeji A AU - Hendriks, Marleen E AU - Boers, Alexander C AU - Eck, Diederik van AU - Rosendaal, Nicole AU - Adenusi, Peju AB - BACKGROUND: While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI) in rural Nigeria. Methods and FINDINGS: We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER) of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA) based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program’s scale up within the State’s healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted) is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730). Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible interval 21.9-152.3), during one-way sensitivity analyses, and when cost, quality, cost and utilization parameters of the base case scenario were changed. The sustainability of this program’s scale up by the State is dependent on further investments in healthcare. CONCLUSIONS: This study provides evidence that the investment made by the KSHI program in rural Nigeria is likely to have been cost-effective; however, further healthcare investments are needed for this program to be successfully expanded within Kwara State. Policy makers should consider supporting financial initiatives to reduce maternal mortality tackling both supply and demand issues in the access to care. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0139048 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria TI - Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria UR - http://hdl.handle.net/11427/14926 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14926
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0139048
dc.identifier.vancouvercitationGomez GB, Foster N, Brals D, Nelissen HE, Bolarinwa OA, Hendriks ME, et al. Improving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeria. PLoS One. 2015; http://hdl.handle.net/11427/14926.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentHealth Economics Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Gomez et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntenatal careen_ZA
dc.subject.otherHealth insuranceen_ZA
dc.subject.otherCost-effectiveness analysisen_ZA
dc.subject.otherNigeriaen_ZA
dc.titleImproving maternal care through a state-wide health insurance program: a cost and cost-effectiveness study in rural Nigeriaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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