Health facility cost of caesarean delivery at tertiary level hospital in Tunisia using time-driven activity-based...

The majority of maternal deaths are preventable, and it is important to mention that most causes can be treated by caesarean section. Meanwhile, the rate of caesarean deliveries has been increasing worldwide in an unprecedented way over the last decades, including in our country. Cost analysis of CS provide insight into the hidden and actual costs involved in the provision of maternal health services by the government and to the households availing themselves of these services. The objective of this study was to determine cost of Caesarean section using TDABC in a tertiary-level government hospital in Tunisia.

We conducted a retrospective costing study using Time-Driven Activity Based costing (TDABC) at the Maternity Department of Farhat Hached University Hospital Center to estimate the cost of caesarean delivery.

The rate of CS was 35.51%. The majority (69.4%) were for multiparous women. Among the 2,615 CS, 764(29.2%) were scheduled and 1,851 (70.8%) were performed for emergency purposes. The total cost of a caesarean delivery was 1,610.83_TND (US$573.04). Personnel costs were were the largest cost drivers (52.88%), distributed as follows: US$ 21.39 (7.05%) in the pre-operative phase, US$ 100.99 (33.33%) in the intra-operative phase, and US$ 180.68 (59.62%) in the post-operative phase. The second highest cost was for medical consumables and medicines (21.74%), with intra-operative phase accounting for the largest share (82.47%), costing a total of 231.85_TND (US$82.47). In the pre and post-operative phases, medical consumables and medicines costs represented 6.69%, and 27.1%, respectively. Regarding the cost of investigations, including radiological and biological examinations, per Caesarean delivery, they ranked third in terms of share of overall costs, totalling: US$108.7, which represented 18.97% of the cost per caesarean delivery. As for indirect costs, we found that the largest portion was allocated to the depreciation of buildings, equipment and maintenance, while the smallest share went to pooled indirect costs, estimated at US$36.65.

The total cost of caesarean delivery in our study was 1,610.83TND (US$573.04). Personnel costs were the largest cost drivers. The second highest cost was for medical consumables and medicines and investigations ranked third. Cost analysis of obstetric interventions is essential to estimate the impact of obstetric practices on healthcare resources. There is a need for the state to adopt innovative strategies and mechanisms to reduce informal payments for obstetric services in the public sector.