METHODS: This study employed a cross-sectional design that involved six public primary care facilities in Negeri Sembilan, Malaysia. The PNC-related costs data were collected between May and July 2017, utilising cost data for the year 2016 and involving 287 eligible mothers. The PNC costs were calculated using mixed top-down and activity-based costing (ABC) approaches.
RESULTS: The mean cost of PNC per patient was RM165.65 (median, RM167.12). Personnel cost was the main cost driver for PNC, which accounted for the most significant proportion of the total cost at 94.2%. Education level, type of health facilities and postnatal visits were positively associated with the total PNC cost.
CONCLUSION: This study highlighted the average cost of PNC in the public primary care facilities in Negeri Sembilan. The cost of PNC was revealed to be primarily driven by personnel cost. The findings of this pilot study could add to the evidence base of PNC and serve as a vital reference for improving future estimates to better allocate scarce resources.
METHODS: A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model.
RESULTS: Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies.
CONCLUSIONS: The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.