title: Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana.
abstract: OBJECTIVE
  This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana.
  
  
  METHODS
  A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost.
  
  
  RESULTS
  Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%.
  
  
  CONCLUSIONS
  The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany; Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: Maxwell Ayindenaba
authors.initials: MA
authors.lastname: Dalaba
authors.affiliation: University of Ghana, School of Public Health, Accra, Ghana.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany; Muhimbili University of Health and Allied Sciences, Behavioural Sciences Department, School of Public Health and Social Sciences, Dar es Salaam, Tanzania.
authors.forename: Happiness Pius
authors.initials: HP
authors.lastname: Saronga
authors.affiliation: Medical University, Surgical Clinic, Pleven, Bulgaria.
authors.forename: Pencho
authors.initials: P
authors.lastname: Tonchev
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana; Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mensah
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Blank
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kaltschmidt
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany.
authors.forename: Svetla
authors.initials: S
authors.lastname: Loukanova
mesh_terms: D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical / Q000191:economics*; D036861:Delivery, Obstetric / Q000191:economics*; D005260:Female; D005869:Ghana; D017048:Health Care Costs; D006284:Health Plan Implementation; D006801:Humans; D007743:Labor, Obstetric; D008427:Maternal Health Services / Q000191:economics*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*; D012017:Referral and Consultation