Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study

Abstract

BackgroundQUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania.MethodsThis was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider’s perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios.ResultsEconomic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes.ConclusionsAlthough the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system.Trial registrationRegistered clinical trial at www.clinicaltrials.gov (NCT01409824). Registered May 2009.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2457-z) contains supplementary material, which is available to authorized users.

The Nurse Assistant App

“…This result does not confirm the hypothesis that the use of an eCDSS would increase the number of essential ANC interventions. However, this unexpected result is consistent with previous studies conducted on the effects of an eCDSS in Ghana and South Africa, which demonstrated that although the performance of healthcare workers improved somewhat, no significant improvement in the overall quality score of ANC was found after implementation of the eCDSS (Horner et al, 2013;Mensah et al, 2015;Saronga et al, 2017). Our results may indicate that at intervention facilities where the NAA was used, essential components of ANC service delivery were skipped more than in control facilities.…”

“…Respondents mentioned that they believed an eCDSS would especially improve record-keeping, performance of healthcare workers, and communication between healthcare workers and pregnant women (Van Pelt et al, 2020;. However, a program implementing an eCDSS in three sub-Saharan African countries found no significant improvement in the overall quality of the delivery of ANC (Mensah et al, 2015;Saronga et al, 2017). Evaluating the impact of an eCDSS on daily work practices and quality of care is essential when considering sustained use of a digital health tool among healthcare workers.…”

Clinical Decision Support Systems

“…Also, in other medical areas such as the gynecological care in rural areas with supposedly poor medical infrastructure in Tanzania or Ghana, an improvement of the processes (by CDSS support) did not yet lead a higher cost efficiency [56, 57]. In summary, the current study situation is heterogeneous, and CDSS may not always be clearly cost effective.…”

Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study

“…Considering only additional costs implementing computer-assisted CDSSs, the cost per pregnancy complication detected was US $285 [ 20 ]. In Tanzania, ICERs were 2013 US $2469 and US $338 per 1% change in process quality for antenatal and childbirth care, respectively [ 4 ].…”