Dalaba Maxwell Ayindenaba, Akweongo Patricia, Aborigo Raymond Akawire, Saronga Happiness Pius, Williams John, Blank Antje, Kaltschmidt Jens, Sauerborn Rainer, Loukanova Svetla
University of Heidelberg, Institute of Public Health, Heidelberg, Germany; Navrongo Health Research Centre, Navrongo, Ghana.
University of Ghana, School of Public Health, Accra, Ghana.
PLoS One. 2015 May 14;10(5):e0125920. doi: 10.1371/journal.pone.0125920. eCollection 2015.
This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS) in the identification of maternal complications in Ghana.
A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.
Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC) in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010). In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305). Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio) decreased from US$17,017.58 (before-intervention) to US$15,207.5 (after-intervention). Incremental cost -effectiveness ratio (ICER) was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS), cost per pregnancy complication detected was US$285.
Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth the additional cost.
本文研究了计算机辅助临床决策支持系统（CDSS）在加纳识别孕产妇并发症方面的成本效益。
在一项干预前后研究中进行了成本效益分析。分析是从提供者的角度进行的。干预地区是卡塞纳-南卡纳区，在六个选定的卫生中心，助产士在孕产妇护理中使用了计算机辅助CDSS。布伊萨区的六个选定卫生中心作为非干预组，正常开展加纳卫生服务活动。
计算机辅助CDSS提高了干预卫生中心产前护理（ANC）期间妊娠并发症的检出率（干预前=每1000次ANC就诊9例；干预后=每1000次ANC就诊12例；P值=0.010）。在干预卫生中心，分娩期间并发症数量减少了1.1%，尽管差异无统计学意义（干预前=每1000名分娩客户107例；干预后=每1000名分娩客户96例；P值=0.305）。此外，在干预卫生中心，ANC期间检测到的每例妊娠并发症的平均成本（成本效益比）从17,017.58美元（干预前）降至15,207.5美元（干预后）。增量成本效益比（ICER）估计为1142美元。仅考虑额外成本（计算机辅助CDSS的成本），检测到的每例妊娠并发症的成本为285美元。
计算机辅助CDSS有潜力识别孕期并发症，并使分娩并发症略有减少。与常规孕产妇护理相比，实施计算机辅助CDSS成本更高，但在检测妊娠并发症方面更有效，因此实施CDSS的决策非常复杂。然而，政策制定者应根据额外收益是否值得额外成本来做出指导。
