Heidelberg Institute of Global Health, University Hospital, University of Heidelberg, Heidelberg, Germany.
Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
Value Health. 2020 Mar;23(3):300-308. doi: 10.1016/j.jval.2019.10.007. Epub 2020 Jan 17.
The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption interventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region.
We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence.
Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted.
Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries.
降低和免除基本医疗服务的用户费用最近已成为在撒哈拉以南非洲推进全民健康覆盖的关键手段，但尚未有其成本效益的证据。我们旨在通过估计布基纳法索 2007 年至 2015 年期间 2 项用户费用豁免干预措施的成本效益来填补这一空白：全国 80%的分娩护理服务用户费用减免政策和萨赫勒地区的用户费用免除试点（即完全免除分娩护理的用户费用）。
我们构建了一个单一的决策树来评估这两项研究干预措施和基线的成本效益。决策树中纳入了自身影响评估和最佳的现有流行病学证据。
与基线相比，全国 80%的用户费用减免政策和用户费用免除试点都具有很高的成本效益，避免每个残疾调整生命年的增量成本效益比分别为 210.22 美元和 252.51 美元。与全国 80%的用户费用减免政策相比，用户费用免除试点的增量成本效益比为避免每个残疾调整生命年的 309.74 美元。
我们的研究表明，布基纳法索从 80%的减免转向完全免除分娩护理的用户费用是值得的。应进行本地分析，以确定在其他撒哈拉以南非洲国家实施用户费用豁免是否值得。
