Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing

Odhiambo, Jackline; Ruhumuriza, John; Nkurunziza, Theoneste; Riviello, Robert; Shrime, Mark G.; Lin, Yihan; Rusangwa, Christian; Omondi, Jack; Toma, Gabriel; Nyirimodoka, Alexandre; Mpunga, Tharcisse; Hedt‐Gauthier, Bethany

doi:10.1007/s10995-018-2674-z

Cited by 26 publications

(37 citation statements)

References 36 publications

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“…Thus, 22 studies were included in our narrative review of which 15 provided disaggregated component cost for our analysis (figure 1). Nineteen of the included studies were retrieved from peer-review literature, [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] while the remaining three were sourced from grey literature. [46][47][48] distribution and quality assessment of included studies Thirteen studies were conducted in low-income countries (LICs) including four in Rwanda, 35 41 45 46 two each in Tanzania 32 36 and Uganda 29 34 and one each in Burkina Faso, 43 Democratic Republic of the Congo, 27 Ethiopia, 33 Haiti 48 and Somalia.…”

Section: Resultsmentioning

confidence: 99%

“…27 30 31 33-36 41 44 45 48 This included five studies that used methodologies that were variants of the ingredient approach-PACCM 31 33-35 and the time-driven activitybased costing (TDABC). 45 Six studies used the expenditure approach 32 39 42 43 46 47 and three studies used a mixed approach combining both. 37 38 40 Two studies did not state the costing methods used.…”

Section: Resultsmentioning

confidence: 99%

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The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

et al. 2020

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IntroductionMaternal health services are effective in reducing the morbidity and mortality associated with pregnancy and childbirth. We conducted a systematic review on costs of maternal health services in low-income and middle-income countries from the provider’s perspective.MethodsWe searched multiple peer-reviewed databases (including African Journal Online, CINAHL Plus, EconLit, Popline, PubMed, Scopus and Web of Science) and grey literature for relevant articles published from year 2000. Articles meeting our inclusion criteria were selected with quality assessment done using relevant cost-focused criteria of the Consolidated Health Economic Evaluation Reporting Standards checklist. For comparability, disaggregated costs data were inflated to 2019 US$ equivalents. Costs and cost drivers were systematically compared. Where heterogeneity was observed, narrative synthesis was used to summarise findings.ResultsTwenty-two studies were included, with most studies costing vaginal and/or caesarean delivery (11 studies), antenatal care (ANC) (9) and postabortion care (PAC) (8). Postnatal care (PNC) has been least costed (2). Studies used different methods for data collection and analysis. Quality of peer-reviewed studies was assessed average to high while all grey literature studies were assessed as low quality. Following inflation, estimated provision cost per service varied (ANC (US$7.24–US$31.42); vaginal delivery (US$14.32–US$278.22); caesarean delivery (US$72.11–US$378.940; PAC (US$97.09–US$1299.21); family planning (FP) (US$0.82–US$5.27); PNC (US$5.04)). These ranges could be explained by intercountry variations, variations in provider type (public/private), facility type (primary/secondary) and care complexity (simple/complicated). Personnel cost was mostly reported as the major driver for provision of ANC, skilled birth attendance and FP. Economies of scale in service provision were reported.ConclusionThere is a cost savings case for task-shifting and encouraging women to use lower level facilities for uncomplicated services. Going forward, consensus regarding cost component definitions and methodologies for costing maternal health services will significantly help to improve the usefulness of cost analyses in supporting policymaking towards achieving Universal Health Coverage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

et al. 2020

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“…At the core of this problem is the lack of accurate cost information associated with speci c medical interventions. Recently, time-driven activity-based costing is put forward as suitable, more precise costing method to provide detailed and dynamically cost insights in a complex environment such as hospitals (10,18,21). The purpose of this study was the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department.…”

Section: Discussionmentioning

confidence: 99%

“…Our study provides new perspectives on the estimation of cost of childbirth in a hospital, and on the determinants driving cost variability. First, while a number of studies have already identi ed that age, parity and education attainment can drive variability in overall cost of childbirth, our study differs from existing studies in the use of the time-driven activity-based costing approach to analyse the impact of several patient and disease characteristics on cost of childbirth (6,(17)(18)(19)(20)26). In addition to providing more accurate cost estimates than traditional methods, this technique allows to exactly identify which activities and resources are most heavily impacted by these characteristics (Porter, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Based on medical literature review, four patient characteristics that were found to in uence the clinical pathway are included in the analysis. In particular, age, parity, gestation weeks and education attainment were put forward as they were associated with various obstetric complications and additional patient care (6,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

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A Time-Driven Activity-Based Costing Approach for Identifying Variability in Costs of Childbirth Between and within Types of Delivery

Dubron

Verschaeve

Roodhooft

2021

Preprint

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Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is to demonstrate how the overall cost of childbirth at the maternity department can be calculated by implementing a TDABC analysis. In addition, this study outlines how this costing method can be utilized to provide insights into how patient and disease characteristics drive variability within childbirth cost. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.Methods Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+33,3 min) and monitoring (+775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.

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Economic impact of surgery on households and individuals in low income countries: A systematic review

Platt

Doe

Kim

et al. 2021

International Journal of Surgery

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Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing

Cited by 26 publications

References 36 publications

The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

A Time-Driven Activity-Based Costing Approach for Identifying Variability in Costs of Childbirth Between and within Types of Delivery

Economic impact of surgery on households and individuals in low income countries: A systematic review

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