title: Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger.
abstract: OBJECTIVE
  The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high-impact, evidence-based care standards. Intervention costs and cost-effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale-up the intervention to additional sites.
  
  
  METHODS
  Facility-based maternal care outcomes and costs from pre-quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records.
  
  
  RESULTS
  The average delivery-cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost-effectiveness was $147/disability-adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost-savings and improved health outcomes can be predicted.
  
  
  CONCLUSIONS
  The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources.
  
  
  CONCLUSIONS
  This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.
authors.affiliation: USAID Health Care Improvement Project, University Research Co., Bethesda, Maryland, USA. ebroughton@urc-chs.com
authors.forename: Edward
authors.initials: E
authors.lastname: Broughton
authors.forename: Zakari
authors.initials: Z
authors.lastname: Saley
authors.forename: Maina
authors.initials: M
authors.lastname: Boucar
authors.forename: Dondi
authors.initials: D
authors.lastname: Alagane
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hill
authors.forename: Aicha
authors.initials: A
authors.lastname: Marafa
authors.forename: Yaroh
authors.initials: Y
authors.lastname: Asma
authors.forename: Karimou
authors.initials: K
authors.lastname: Sani
mesh_terms: D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration*; D009010:Monte Carlo Method; D009548:Niger; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D019057:Quality-Adjusted Life Years