Chamani Amisa Tindamanyile, Robberstad Bjarne, Mori Amani Thomas
Department of Global Public Health and Primary Care, Section for Ethics and Health Economics Bergen, University of Bergen, Bergen, Norway.
Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Appl Health Econ Health Policy. 2025 Jan;23(1):93-104. doi: 10.1007/s40258-024-00923-y. Epub 2024 Oct 26.
Tanzania recently changed its antenatal care (ANC) guidelines to reduce perinatal mortality and improve the experience of pregnancy care. The new guideline recommends increasing the number of ANC visits from four to eight and introducing one routine ultrasound scan, among other recommendations. We estimated the budget impact of implementing the new guideline compared to the previous focused ANC guideline at public dispensaries and health centers.
In a dynamic Markov model, we prospectively followed annual cohorts of between 2.3 and 2.6 million pregnant women who will be attending ANC at dispensaries and health centers for 5 years. We allowed a population of pregnant women into the model every year and women exit the model at delivery. We calculated the cost of medicines, medical supplies, and laboratory supplies required to produce services from a public health system perspective. Our model neither estimated condition-related costs nor health effects. The budget impact was calculated as the difference in the estimated costs between the two guidelines. We conducted scenario analyses to explore attending more visits and different assumptions to calculate the target population.
We estimated that implementing the new ANC guideline would have a cumulative budget impact of around US$154 million over 5 years. The budget required will increase from US$137 million under the focused ANC guideline to US$291 million under the new guideline. Laboratory supplies will consume 47% of the estimated budget under the new guideline. We expect the annual budget impact to be US$38 million in the first year of implementation and US$32 million in the fifth year. We assumed that by the fifth year, 82% of all pregnant women would have had four or more visits. The budget impact would increase to US$214 million, with the proportion of pregnant women attending four or more ANC visits reaching 90% within 5 years.
Scaling up the implementation of the new ANC guideline at public dispensaries and health centers may substantially increase the supplies required to produce ANC services, particularly laboratory supplies. Studies on the health impact of the new guideline are warranted to estimate the value for money.
坦桑尼亚最近修改了其产前保健（ANC）指南，以降低围产期死亡率并改善孕期保健体验。新指南建议将产前保健就诊次数从4次增加到8次，并引入一次常规超声检查，以及其他一些建议。我们估计了在公共诊所和卫生中心实施新指南相较于之前重点产前保健指南的预算影响。
在一个动态马尔可夫模型中，我们前瞻性地跟踪了每年230万至260万将在诊所和卫生中心接受产前保健的孕妇队列，为期5年。我们每年让一批孕妇进入模型，孕妇在分娩时退出模型。我们从公共卫生系统的角度计算了提供服务所需的药品、医疗用品和实验室用品的成本。我们的模型既没有估计与病情相关的成本，也没有估计健康影响。预算影响通过计算两种指南估计成本之间的差异得出。我们进行了情景分析，以探讨增加就诊次数以及计算目标人群的不同假设。
我们估计，实施新的产前保健指南在5年内的累计预算影响约为1.54亿美元。所需预算将从重点产前保健指南下的1.37亿美元增加到新指南下的2.91亿美元。在新指南下，实验室用品将占估计预算的47%。我们预计实施第一年的年度预算影响为3800万美元，第五年为3200万美元。我们假设到第五年，所有孕妇中有82%将进行4次或更多次就诊。预算影响将增至2.14亿美元，5年内进行4次或更多次产前保健就诊的孕妇比例将达到90%。
在公共诊所和卫生中心扩大新产前保健指南的实施规模可能会大幅增加提供产前保健服务所需的用品，尤其是实验室用品。有必要对新指南的健康影响进行研究，以评估其性价比。
