Cost-effectiveness of using standardization of care and auditing of critical cases of severe preeclampsia

Purpose of the study. To evaluate the cost-effectiveness of using standardized approaches to care and auditing critical cases of mothers with critically severe preeclampsia

Material and research methods. We analyzed reports of cases of critical severe preeclampsia that occurred in the State Institution “Research Institute of AH and P” of the Ministry of Health and SZN of the Republic of Tatarstan. using critical incident audits from 2018 to 2022.When conducting ACС, the methodology and principles of this technology were observed - non-punishment, confidentiality, comparison of practices with standards based on evidence-based medicine, adherence to the principle of searching for the true reasons for missed opportunities and making decisions, the implementation of which helps to eliminate weak practices.

An analysis of the cost of illness was carried out taking into account all the costs of patients with critical severe preeclampsia at a certain time stage and at all stages of medical care. The total cost includes direct expenses - wages of employees, costs of the institution and women for medicines, equipment, food, depreciation of equipment. Indirect (non-medical) costs are those costs that are not directly related to the treatment process, but create conditions for it, i.e. opportunity costs.

Research results and discussion. To calculate costs, the costs of examination, treatment and hospital stay for selected critical severe preeclampsia were calculated. The calculations took into account the order of care, the list of necessary examinations, step-by-step treatment and criteria for the length of hospital stay for women, according to the national guideline “Hypertensive disorders during pregnancy, childbirth and the postpartum period” (2015). After calculating the costs of examination, treatment costs, and hospital service costs, the list price for various nosologies of critical severe preeclampsia was calculated taking into account profitability, which is the sum of cost and profitability. The total costs of care for women with critical severe preeclampsia were calculated by summing the costs for various nosologies of critical severe preeclampsia.

Summary. Severe preeclampsia is an important socio-economic problem in the healthcare system. Critical severe preeclampsia occupies a leading position in the structure of causes of maternal mortality. The financial cost of providing care to women with critically severe preeclampsia amounts to enormous sums of money. This article examines the cost-effectiveness of using standardization of care and auditing of critical cases of severe preeclampsia. A retrospective analysis of the birth histories of women with critical severe preeclampsia for the period from 2018 to 2022 was carried out. During this period, in cases of non-compliance with standards, critical cases were audited, the true causes of missed opportunities were identified, and effective decisions were made, the implementation of which prevented subsequent recurrence of omissions. The cost of the disease, the dynamics of the reduction in critical severe preeclampsia over the studied period of time and a direct method for calculating effectiveness were analyzed. The results of the study showed that the use of standards and audit of critical cases in practices reduces financial costs.

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