COSTS, BENEFITS, AND COST-EFFECTIVENESS OF IMPLEMENTING THE MOTHER-BABY PACKAGE IN MEXICO
Delphine Hu, MD, MPH and Sue J. Goldie, MD, MPH. Harvard School of Public Health, Boston, MA
Purpose: Under the current standard of maternal health care, the lifetime risk of dying from maternal causes is 1 in 370 in Mexico compared to 1 in 2,500 in the United States. We evaluate the cost-effectiveness of implementing maternal health interventions from the World Health Organization's Mother-Baby Package (MBP) in Mexico. Methods: A computer-based model was developed to simulate pregnancy- and delivery-related complications and used to project the impact of maternal health interventions on maternal mortality and morbidity in a cohort of 100,000 15-year-old Mexican women. We evaluated three main strategies: (1) no intervention, (2) current standard of care (standard care), and (3) MBP standard of care. We also evaluated the effect of (1) implementing individual maternal interventions from the MBP (i.e., 90% coverage of prenatal care, normal delivery with skilled attendance, postnatal care, and treatment of sexually transmitted infections, syphilis, anemia, eclampsia, obstructed labor, postpartum hemorrhage, and sepsis) and (2) increasing safe abortion availability. Data were from national databases and literature. Although there is single threshold incremental cost-effectiveness ratio (ICER) below which an intervention would be considered cost-effective, for comparative purposes to other recently assessed public health interventions, we considered interventions with cost-effectiveness ratios less than the GDP per capita ($10,000 in Mexico) to be “very cost-effective”. Results: Implementing the MBP standard of care was the most effective strategy, preventing approximately 38% of maternal deaths and 33% of maternal long-term complications, compared to standard care. The WHO package of services in MBP dominated standard care and had an ICER of $ 312 per DALY averted, compared to no intervention. Among the individual interventions, the most effective intervention was increasing the coverage of safe abortions by 50%, with an ICER of $1,221 per DALY averted compared to the next best strategy, increasing family planning coverage by 15%. Results were most sensitive to assumptions about intervention costs and assumptions about the underlying rates of maternal mortality and morbidity. Conclusions: In Mexico, the MBP standard of care will prevent more deaths and morbidity than standard care, and with an ICER less than the GDP, appears to be good value for money. However, if implementation of the complete MBP is not economically feasible, policymakers should consider increasing the coverage of safe abortion and/or family planning first priority.