Treatment cost and costing model of obstetric complications at a hospital in Myanmar

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study

Background

Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government's claim of providing free maternal health-care services.

Methods

A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association.

Results

The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (β=1.13; 95% CI: 1.00, 1.26), distance from hospital (β=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (β=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (β=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (β=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (β=0.86; 95% CI = 0.77-0.97).

Conclusion

Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study

OBJECTIVE

Postpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India.

DESIGN

Health system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.

SETTINGS

Four public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.

OUTCOME MEASURES

Unit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017-2018.

RESULTS

Medical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596).

CONCLUSIONS

Atonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state's annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.

The Economic Burden of Abortion and Its Complication Treatment Cares: A Systematic Review

Objective: Abortion related procedures contribute to a significant economic burden because it resulted in prolonged hospital stays for patients. We aimed to gather available evidence on the economic burden of abortion and post-abortion complication treatment cares worldwide.

Materials and methods: PubMed, Web of Science, Scopus, and Embase databases were searched through November 2019. Two researchers independently conducted the quality assessment and data extraction process. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2016 $US).

Results: Totally, 2082 records were retrieved and 32 studies were deemed eligible for qualitative synthesis. The mean total costs per patient with abortion or post-abortion care ranged from $23 to $564. The annual costs ranged from 189,000 $US to 134 million $US.

Conclusion: Abortion and post-abortion care impose a substantial economic burden on society. Understanding the burdensome of abortion or pregnancy termination among policymakers provides vital information and enables informed decisions to be made to establish health care priorities and allocating scarce resources.

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Background

The government of Ethiopia introduced an exemption policy that guarantees free maternal healthcare services from public providers. This policy aims to ensure financial protection and enhance utilization of services especially for low-income people. However, patients in most cases incur health expenditure when seeking health care. This paper aims to assess direct and indirect medical costs of treating maternal complications and associated factors at a public hospital in Northern Ethiopia.

Methods

An institution-based cross-sectional study design was carried on 267 mothers with complications. A multivariate linear regression model at 5% level of significance was used to analyze factors driving the outcome.

Results

The median cost was more than seven times the monthly minimum wage, and this may cause severe financial consequences for the poor. Direct medical costs accounted for the major share (68%) of total cost, and this was mainly driven by lack of diagnostic services at public facilities and paying for private providers. Expenditure for treatment of maternal complications is positively associated with income, absence from work, travel time to the facility and being diagnosed at a private facility.

Conclusion

The overall evidence in this study poses a concern about the context in which fee exemption reforms are being implemented.