コンゴ民主共和国 (DRC) の母親と子供の健康のための財政的インセンティブの経済的評価:クラスターランダム化制御試験に基づく意思決定ツリーモデリング
Wu Zeng1, Gil Shapira2, Tianjiao Gao3
1Department of Global Health, Georgetown University, Washington, DC, USA. wz192@georgetown.edu.
Global health research and policy
|September 2, 2025
まとめ
コンゴ民主共和国におけるパフォーマンスベースの資金調達 (PBF) プログラムは,母子保健サービスの改善のための費用対効果の高い戦略です. このイニシアチブは,MCHサービスの利用率を大幅に増加させ,命を救いました.
科学分野:
- 健康 経済
- 公衆衛生政策
- 母親と子供の健康
背景:
- コンゴ民主共和国は,母子保健サービスの利用を高めるために,2017年にパフォーマンスベースの資金調達 (PBF) プログラムを実施しました.
- クラスターによるランダム化制御試験で,PBFプログラムのインパクトと費用対効果を直接的ファシリティ資金 (DFF) と比較した.
研究 の 目的:
- コンゴ民主共和国におけるMCHサービスのためのDFFプログラムと比較してPBFプログラムの費用対効果を評価する.
- MCHのサービスカバーと品質調整された寿命年 (QALYs) に対するPBFの影響を定量化する.
主な方法:
- 費用対効果を推定するために,MCHサービスコスト,流行病学的データ,およびヘルスケアユーティリティを統合した意思決定ツリーモデルが使用されました.
- QALYの有効性をシミュレートするために,MCHサービスカバーに関するインパクト評価データを使用しました.
- 感受性分析では,介護の質,コスト,およびPBFがMCHサービスに与える影響を調査した.
主要な成果:
- PBFプログラムは20590万米ドル (2017年-2021年) で,インセンティブは70.6%,州購買機関は19.4%でした.
- 年間一人当たりのコストはPBFで2.05ドル,DFFで1.71ドルでした.
- PBFはMCHサービスを改善し,品質調整なしに1,372人の命を救った (192,036 QALYs);インクリメンタルコスト効率比 (ICER) はQALYあたり1,374米ドルで,品質調整により減少した.
結論:
- PBFプログラムは費用対効果の高い戦略であり,世界保健機関が推奨する値 (人当たりGDPの3倍) を超えています.
- 費用対効果の大幅な差異が認められ, 標的を絞った行動が必要となった.
- PBFプログラムを通じて達成されたMCHの獲得を維持することは,持続的な公衆衛生の改善に不可欠です.
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