Costs of publicly provided maternity services in Rosario, Argentina

OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999) of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57) is five times greater than that of a normal vaginal delivery ($105.61). A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94 percent of the total cost and drugs and medical supplies between 4-26 percent. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals

Cost-effectiveness analysis of the impacts on infection and morbidity attributable to three chemotherapy schemes against Schistosoma japonicum in hyperendemic areas of the Dongting Lake region, China.

A study was carried out in 8 villages endemic with S. japonicum in Hunan Province, China from 1998 to 2000 to evaluate the cost-effectiveness in preventing schistosome infection and related morbidity under three chemotherapy schemes: (1) 'clue' chemotherapy, consisting of treatment to those with contact with infected water and/or symptoms of infection; (2) 'mass' chemotherapy-treatment to all the villagers except those not able to take praziquantel; and (3) 'screen' chemotherapy-treatment prescribed to the stool egg positive cases after Kato-Katz examination. An itemized cost menu was used to estimate the cost incurred to each scheme, from the perspective of the health care provider. The numbers of cases prevented by chemotherapy schemes were estimated through standardized attributable fractions of the outcomes to absence of chemotherapy before intervention. The cost-effectiveness ratios were calculated using weighted ranks of unit costs of the four outcome measurements: the costs per case with infection, liver and spleen abnormality (as determined by ultrasonography) prevented and 1% reduction in intensity of infection (as estimated by egg per gram feces, EPG) after the two years of intervention. Sensitivity of total cost to changes in the costs of personnel, praziquantel and other key factors were analyzed. It is demonstrated that all the three schemes had a significant impacts on the prevalence and intensity of infection, but the overall effects on liver and spleen morbidity of the residents varied between schemes. Mass chemotherapy achieved the best cost-effectiveness ratio, with unit costs of preventing cases of infection, liver and spleen abnormality and 1% reduction of EPG being RMB yuan 161.2, 99.8, 219.3 and 176.3, respectively. However, clue and screen chemotherapy schemes did not show significant prevention of liver damages in the villagers. The unit costs per case prevented for the outcomes were RMB yuan 140.2, 602.7 and 169.3, respectively for clue chemotherapy, while RMB yuan 190.0, 448.4 and 145.0 respectively for screen chemotherapy. The study concluded that mass chemotherapy should still be the choice of preference in areas where prevalence of infection and frequencies of contact with infested water by residents are high, particularly if the drug cost could be further reduced. Clue chemotherapy could be an alternative to mass chemotherapy, especially when the frequency of water contact is not as high as 80% recorded in our study. Screen chemotherapy is the least favored option in the hyperendemic area of Hunan Province.