A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso

Table 5 Incremental cost-effectiveness ratios of caesarean deliveries by providers' teams, enhanced strategies*, district hospitals, Burkina Faso, 2006

Providers (Surgical teams led by...)	Total costs of surgical team	Cost per c-section (CFA)	Newborns CFR (/1000 c-sections)
Obstetricians (O)	8 577 736	92 858	99
Trained doctors (D)	4 205 141	45 523	112**
Clinical officers (CO)	3 796 782	41 102	161.5***
Incremental Cost-Effectiveness Ratio (ICER) = incremental cost of performing 1000 c-sections/incremental gain of newborns' lives per 1000 c-sections
ICER from (D) to (O) = (92.858 mi-45.523 mi)/(112-99)			3 641 154
ICER from (CO) to (O) = (92.858 mi-41.102 mi)/(161.5-99)			828 096
ICER from (CO) to (D) = (45.523 mi-41.102 mi)/(161.5-112)			89 313

* Enhanced strategies = enhanced essential surgery and enhanced clinical officers
"Enhanced essential surgery" = two years' degree-seeking training, salary incidence, incentives (management at district level, allowances for living conditions in remote areas, and possibility to directly join obstetricians' or surgeons' training class with validation of first year); assumptions of 15 years' practice, and advantage of not losing critical life saving to public health training and practice
"Enhanced clinical officers" = current clinical officers subjected every two years to a refresher course coupled with an effective supervision programme
** Hypothetical figure of outcomes of "enhanced essential surgery" after two year training programme
*** Hypothetical figure of outcomes of "enhanced clinical officers" after refresher courses and effective supervision

ISSN: 1478-4491