Maternal outcomes and cost-effectiveness of alternative strategies to improve maternal health compared with status quo in Mexico.*

*DALY = Disability adjusted life years, ICER = incremental cost-effectiveness ratio; IpC = intrapartum care; EmOC = emergency obstetric care; FP = family planning. Strategies increase coverage of specific interventions above the coverage rates in current practice. These include enhanced high-quality intrapartum care for all pregnant women (81% to 100%) and enhancing access to comprehensive emergency obstetric care for at least 90% (81% to 90%), safe abortion (from 50% to 100%), and FP (from 59% to 74% in women age 20 and older, and from 18% to 33% in women younger than age 20). All strategies are compared to current coverage; incremental cost-effectiveness ratios are assessed by ranking the strategies from the least costly to most costly and calculating the incremental change in costs and benefits compared to the next best strategy. For strategies that include enhanced IpC/EmOC access we assumed an incremental cost of $18.50 per woman requiring referral. Also see results section.
†Cost savings relative to current practice (per 100,000 women) is an indicator of the resources that would be saved over the lifetime of a cohort of 100,000 women relative to current practice in Mexico if a particular strategy was adopted. This savings is calculated as the difference in total lifetime costs for a strategy compared to current practice, multiplied by 100,000.
‡Increased family planning (74% in women age 20 and older, 33% in women younger than age 20) with increased safe abortion (100%) is more effective and less costly than current practice in Mexico.
§Increased family planning (74% in women age 20 and older, 33% in women younger than age 20) with increased safe abortion (100%) and enhanced IpC/EmOC access (100%/90%) has a cost-effectiveness ratio of $300/DALY compared to the next best strategy of increased family planning with increased safe abortion alone.
||Strategy is less effective and more costly than increased family planning (74% in women age 20 and older, 33% in women younger than age 20) with increased safe abortion (100%) and enhanced IpC/EmOC access (100%/90%) and is therefore formally dominated. Compared to current practice, these strategies are still cost saving.