While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .
WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care
BACKGROUND We undertook a multicentre r and omised controlled trial that compared the st and ard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits . METHODS Clinics in Argentina , Cuba , Saudi Arabia , and Thail and were r and omly allocated to provide either the new model ( 27 clinics ) or the st and ard model currently in use ( 26 clinics ) . All women presenting for antenatal care at these clinics over an average of 18 months were enrolled . Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions . Those who did not require further specific assessment or treatment were offered the basic component of the new model , and those deemed at higher risk received the usual care for their conditions ; however , all were included in the new-model group for the analyses , which were by intention to treat . The primary outcomes were low birthweight ( < 2500 g ) , pre-eclampsia/eclampsia , severe postpartum anaemia ( < 90 g/L haemoglobin ) , and treated urinary-tract infection . There was an assessment of quality of care and an economic evaluation . FINDINGS Women attending clinics assigned the new model ( n=12568 ) had a median of five visits compared with eight within the st and ard model ( n=11958 ) . More women in the new model than in the st and ard model were referred to higher levels of care ( 13.4 % vs 7.3 % ) , but rates of hospital admission , diagnosis , and length of stay were similar . The groups had similar rates of low birthweight ( new model 7.68 % vs st and ard model 7.14 % ; stratified rate difference 0.96 [ 95 % CI -0.01 to 1.92 ] ) , postpartum anaemia ( 7.59 % vs 8.67 % ; 0.32 ) , and urinary-tract infection ( 5.95 % vs 7.41 % ; -0.42 [ -1.65 to 0.80 ] ) . For pre-eclampsia/eclampsia the rate was slightly higher in the new model ( 1.69 % vs 1.38 % ; 0.21 [ -0.25 to 0.67 ] ) . Adjustment by several confounding variables did not modify this pattern . There were negligible differences between groups for several secondary outcomes . Women and providers in both groups were , in general , satisfied with the care received , although some women assigned the new model expressed concern about the timing of visits . There was no cost increase , and in some setting s the new model decreased cost . INTERPRETATIONS Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes . It could be implemented without major resistance from women and providers and may reduce cost
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .