Cost-effectiveness of maternal and neonatal health interventions in Ethiopia: a systematic review and meta-analysis.

IF 3.4 3区经济学 Q1 ECONOMICS

Health Economics Review Pub Date : 2026-05-20 DOI:10.1186/s13561-026-00754-8

Akalu Duguma Sima, Endale Tamiru Burayu, Zelalem Banjaw Zegeye

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引用次数: 0

Abstract

Background: Despite recent improvements in health service coverage, maternal and neonatal mortality remain major public health concerns in Ethiopia. Evidence regarding cost-effectiveness is crucial for prioritizing interventions within the Essential Health Services Package, particularly in resource-constrained settings.

Objective: This study aims to systematically review and conduct a meta-analysis on the cost-effectiveness of maternal and neonatal health (MNH) interventions in Ethiopia.

Methods: We conducted a comprehensive search across multiple databases (PubMed/MEDLINE, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, African Journals Online; including the Ethiopian Journal of Health Development, Tufts Cost-Effectiveness Analysis Registry, and Google Scholar) from January 2000 to December 2024. A total of twelve studies were included in the qualitative synthesis and meta-analysis. A random-effects meta-analysis was performed for interventions with three or more comparable estimates utilizing the DerSimonian-Laird method.

Results: The pooled incremental cost-effectiveness ratios (ICERs) showed high cost-effectiveness for key neonatal interventions: US$6.23 per DALY averted (95% CI: 4.22-8.23; I² = 64.10%; n = 4) for neonatal resuscitation and US$8.78 per DALY averted (95% CI: 3.78-13.77; I² = 90.98%; n = 3) for neonatal sepsis management. Antenatal care had a pooled ICER of US$91.93 per DALY averted (95% CI: 62.84-121.02; I² = 79.65%; n = 5). The overall pooled ICER across all 12 studies was US$15.47 per DALY averted (95% CI: 11.07-19.87; I² = 94.14%), but high heterogeneity (primarily due to intervention diversity) severely limits direct comparability; subgroup analyses provide the most reliable insights.

Conclusion: Neonatal resuscitation, sepsis management, and antenatal care are cost-effective interventions (all pooled ICERs substantially below commonly referenced Ethiopian contextual benchmarks, such as around 1 × projected 2025 GDP per capita of ≈US$950-1,100 per DALY averted, though we note debates on GDP-based approaches and the importance of opportunity costs and affordability). Community-based scale-up in rural regions can optimize outcomes.

Trial registration: PROSPERO registration number: CRD420251182108.

查看原文本刊更多论文

埃塞俄比亚孕产妇和新生儿健康干预措施的成本效益：系统回顾和荟萃分析。

背景：尽管最近保健服务覆盖面有所改善，但孕产妇和新生儿死亡率仍然是埃塞俄比亚主要的公共卫生问题。关于成本效益的证据对于确定一揽子基本卫生服务措施的优先次序至关重要，特别是在资源有限的情况下。目的：本研究旨在系统回顾并对埃塞俄比亚孕产妇和新生儿健康（MNH）干预措施的成本效益进行荟萃分析。方法：从2000年1月至2024年12月，我们在多个数据库（PubMed/MEDLINE、Embase、Cochrane图书馆、CINAHL、Scopus、Web of Science、African Journals Online；包括Ethiopian Journal of Health Development、Tufts Cost-Effectiveness Analysis Registry和谷歌Scholar）中进行了全面的检索。定性综合和荟萃分析共纳入12项研究。采用dersimonan - laird方法对具有三个或更多可比较估计值的干预措施进行随机效应荟萃分析。结果：合并增量成本-效果比（ICERs）显示，关键新生儿干预措施的成本-效果较高：新生儿复苏每避免DALY 6.23美元（95% CI: 4.22-8.23; I2 = 64.10%; n = 4），新生儿败血症管理每避免DALY 8.78美元（95% CI: 3.78-13.77; I2 = 90.98%; n = 3）。产前保健的总ICER为每个避免的DALY 91.93美元（95% CI: 62.84-121.02; I2 = 79.65%; n = 5）。所有12项研究的总合并ICER为每避免DALY 15.47美元（95% CI: 11.07-19.87; I2 = 94.14%），但高度异质性（主要是由于干预措施的多样性）严重限制了直接可比性；分组分析提供了最可靠的见解。结论：新生儿复苏、败血症管理和产前保健是具有成本效益的干预措施（所有综合ICERs都大大低于通常参考的埃塞俄比亚背景基准，例如，预计2025年人均GDP约为1倍，每避免的DALY约为950- 1100美元，尽管我们注意到关于基于GDP的方法以及机会成本和可负担性的重要性的争论）。在农村地区以社区为基础扩大规模可以优化结果。试验注册：普洛斯彼罗注册号：CRD420251182108。

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来源期刊

Health Economics Review Multiple-

CiteScore

3.90

自引率

4.20%

发文量

审稿时长

13 weeks

期刊介绍： Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.