OBJECTIVES: Prenatal counselling has been shown to improve child and maternal outcomes. We assessed the cost-effectiveness of government provided prenatal counselling services in selected health centers across six districts in Uganda.

METHODS: A Markov model was developed to evaluate the cost-effectiveness, from the government-health provider perspective, of government provided prenatal counselling compared to a no-government intervention option, across Kampala, Mbarara, Gulu, Jinja, Wakiso, and Mpigi districts in Uganda. The model estimated costs and outcomes over a ten-year time horizon with 6-months Markov cycles. Model inputs (costs and outcomes) were based on published literature and costs and outcomes were discounted at 3%, and historical costs were adjusted to 2017 US$. Probabilistic sensitivity analysis (PSA) was conducted to account for parameter uncertainty. Cost-effectiveness was evaluated as incremental cost effectiveness ratios (ICERs) based on incremental cost (US$) and incremental benefit as quality adjusted life years (QALYs).

RESULTS: Over a 10-year time horizon, government provided prenatal counselling services were more costly (US$10,671.92 per person) but yielding greater health outcomes (0.89 QALYs) than the option of no government intervention (US$3,230.04 per person) with 0.13 QALYs. This translated into an ICER of US$9,791.95/QALY for government provided prenatal compared to a no-government option. The PSA showed results were robust.

CONCLUSIONS: Assuming a willingness to pay threshold of $10,000/QALY for Uganda, government provided prenatal counselling services is a cost effective health intervention.