Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
BMJ Glob Health. 2024 Mar 28;9(3):e013643. doi: 10.1136/bmjgh-2023-013643.
Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes.
The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars.
Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted.
MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.
为了实现降低母婴死亡率的可持续发展目标，需要扩大和加强优质的母婴保健服务。助产士主导的分娩中心（MLBC）是低风险妊娠替代医院护理的一种选择，分娩时的主导专业人员是经过培训的助产士。许多国家已经在使用这些中心来改善分娩结果。
成本分析使用了孟加拉国、巴基斯坦和乌干达的四个 MLBC 的原始数据收集（n=12 个 MLBC 地点）。对模型成本效益分析进行了比较，以比较每个国家 MLBC 与标准护理的增量成本效益比（ICER），以每避免一个残疾调整生命年（DALY）的增量成本来衡量。结果以 2022 年美元呈现。
MLBC 中的每个分娩的成本在各国内部和之间差异很大，从孟加拉国第 3 个地点的每个分娩 21 美元到乌干达第 2 个地点的 2374 美元。助产士工资和设施运营成本是大多数 MLBC 成本的主要驱动因素。在 12 个 MLBC 中有 6 个在成本较低的情况下产生了更好的健康结果（占主导地位），与标准护理相比；有 3 个在成本较高的情况下产生了更好的健康结果，ICER 范围从每避免一个 DALY 的 571 美元到每避免一个 DALY 的 55942 美元。
MLBC 似乎能够以更低的成本或具有更高的成本效益来产生更好的健康结果，与标准护理相比。成本确实因地点和环境而异，因此作为实施和建立活动的一部分，进一步探索成本和成本效益应成为优先事项。
