Zeng Wu, Shapira Gil, Gao Tianjiao, Muvudi Michel, Li Guohong, Bouey Jennifer, Antwisi Delphin, Yamani Fatma El Kadiri El
Department of Global Health, Georgetown University, Washington, DC, USA.
World Bank, Washington, DC, USA.
Glob Health Res Policy. 2025 Sep 1;10(1):41. doi: 10.1186/s41256-025-00435-9.
To improve the utilization of maternal and child health (MCH) services, the Democratic Republic of the Congo initiated a performance-based financing (PBF) program in 2017. An impact evaluation of the PBF program was conducted in 2023 using a cluster randomized controlled trial research design. This study aimed to assess the cost-effectiveness of the PBF program in comparison with the direct facility financing (DFF) program.
A decision-tree model incorporating key MCH services was developed to estimate cost-effectiveness. Data on costs of maternal health services, epidemiological consequences, and utilities of various health statuses were obtained from the literature. The impact evaluation results on the coverage of key MCH services were included as key inputs to simulate the effectiveness measured as quality-adjusted life years (QALYs). Sensitivity analyses were conducted on the inclusion of the PBF's impact on the quality of care and the uncertainty regarding the costs and the impact of PBF on MCH services.
A total of US$205.9 million in 2021 dollar was spent on the PBF arm over the five years (2017-2021), with 70.60% allocated as incentive payments to health facilities and 19.41% as financial transfers to provincial purchasing agencies for contracting PBF facilities and managing the PBF program. On average, the annual cost per capita was estimated at US$2.05 and US$1.71 for implementing the PBF and DFF program, respectively. Without the quality adjustment, the improvement in MCH services resulted in 1,372 lives (192,036 QALYs) saved over 2017-2021. The incremental cost-effectiveness ratio (ICER) of the PBF program reached US$ 1,374 per QALY with substantial variation. After adjusting for quality, the ICER of PBF became smaller.
Using three times the gross domestic product per capita in 2021 (US$1,732) as the threshold, the PBF program is a cost-effective strategy, though with substantial variation. It is crucial to take action to maintain gains from the improved MCH coverage resulting from the PBF program.
为提高妇幼保健（MCH）服务的利用率，刚果民主共和国于2017年启动了基于绩效的融资（PBF）计划。2023年采用整群随机对照试验研究设计对PBF计划进行了影响评估。本研究旨在评估PBF计划与直接设施融资（DFF）计划相比的成本效益。
开发了一个包含关键妇幼保健服务的决策树模型来估计成本效益。从文献中获取了孕产妇保健服务成本、流行病学后果以及各种健康状况效用的数据。对关键妇幼保健服务覆盖范围的影响评估结果作为关键输入，以模拟以质量调整生命年（QALYs）衡量的有效性。对PBF对护理质量的影响以及PBF对妇幼保健服务成本和影响的不确定性进行了敏感性分析。
在2017 - 2021年的五年中，PBF组以2021年美元计算共支出2.059亿美元，其中70.60%作为激励支付给卫生设施，19.41%作为财政转移支付给省级采购机构，用于与PBF设施签约和管理PBF计划。实施PBF和DFF计划的人均年成本估计分别为2.05美元和1.71美元。在未进行质量调整的情况下，2017 - 2021年期间妇幼保健服务的改善挽救了1372条生命（192,036个QALYs）。PBF计划的增量成本效益比（ICER）达到每QALY 1374美元，存在较大差异。在进行质量调整后，PBF的ICER变小。
以2021年人均国内生产总值的三倍（1732美元）作为阈值，PBF计划是一种具有成本效益的策略，尽管存在较大差异。采取行动维持PBF计划带来的妇幼保健覆盖率提高所取得的成果至关重要。
