RESUMO
The WHO is testing a new rationalised programme of antenatal care in a multicentre randomised trial. The motivation for this trial arose from the current uncertainty about the effectiveness of different approaches to provision of routine antenatal care. Decision makers also lack information about the costs of providing routine antenatal care and the cost-effectiveness of one programme over another. Such information will be needed before the final choice of programme can be made. The WHO trial provides an ideal opportunity to estimate and compare the incremental costs and cost-effectiveness of the new programme in four countries (Argentina, Cuba, Saudi Arabia, Thailand). A separate economic component has been organised to measure the costs of antenatal care. Methods for cost identification and measurement, and methods for economic analysis in the context of an international study are based on current recommendations for the conduct of economic evaluations alongside trials. However, several aspects require further development. In particular, this includes defining standard methods for costing in different countries; measuring women's costs of access to care; and making comparisons across international settings. The economic evaluation will also inform similar multicentre international trials and investigate issues of generalisability beyond trial settings.
PIP: Economic estimations at the technology assessment stage of health interventions permit early recognition of the relative efficiencies of health care interventions and allow those that are expensive and have limited health effects to be discouraged from widespread adoption. The World Health Organization (WHO) Antenatal Care Randomized Controlled Trial includes a component aimed at estimating the incremental costs and cost-effectiveness of a new rationalized program of prenatal care relative to those associated with the standard prenatal care package. 2400 pregnant women attending 53 clinics in Argentina, Cuba, Thailand, and Saudi Arabia have been enrolled. The central concern is that the new program of prenatal care does not result in higher overall costs to either the health care system or women receiving care than the currently practiced model. Resources included in the unit cost estimation are staff, drugs and medications, materials, equipment, vehicles, utilities, and buildings and land. Monthly costing data are being collected at all study sites in Cuba and Thailand over a 12-month period and a questionnaire has been developed to assess the costs borne by women. Data from these two sources will be collated to produce tables of costs at the health facility, country, and international levels. The reliability of the results should be enhanced by the association of the economic analysis with a carefully designed randomized trial intended to minimize bias in terms of differences in the quantities of services used.