title: Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana.
abstract: OBJECTIVE
  This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS) in the identification of maternal complications in Ghana.
  
  
  METHODS
  A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.
  
  
  RESULTS
  Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC) in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010). In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305). Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio) decreased from US$17,017.58 (before-intervention) to US$15,207.5 (after-intervention). Incremental cost -effectiveness ratio (ICER) was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS), cost per pregnancy complication detected was US$285.
  
  
  CONCLUSIONS
  Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth the additional cost.
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: Raymond Akawire
authors.initials: RA
authors.lastname: Aborigo
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: Navrongo Health Research Centre, Navrongo, Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Blank
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, 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: Rainer
authors.initials: R
authors.lastname: Sauerborn
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany.
authors.forename: Svetla
authors.initials: S
authors.lastname: Loukanova
mesh_terms: D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007743:Labor, Obstetric; D000068097:Maternal Health / Q000191:economics; D008427:Maternal Health Services / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics* / Q000453:epidemiology