Los Costos Indirectos de la Mortalidad Materna en Brasil: un Estudio de Costos de Enfermedades

OBJECTIVES: To estimate the indirect cost of maternal mortality in Brazil in terms of economic production forgone as a consequence of the death of a woman during pregnancy, childbirth or within 6 weeks’ postpartum.

METHODS: A cost-of-illness study was conducted with 2015 as the reference year. Secondary data were collected on female life expectancy at birth, proportion of maternal deaths for those aged 15-49 years, total maternal deaths, gross domestic product (GDP) per capita, and the total health expenditure per capita. Data sources included the World Health Organization, UNICEF, UNFPA, the World Bank and the Information System of Live Births of Brazil (SINASC) database of the Ministry of Health, Brazil. The indirect cost was calculated as the loss in non-health GDP attributed to maternal deaths. Estimates of future non-health GDP lost were discounted at a rate of 3.5%. A sensitivity analysis was performed to recalculate the indirect cost at discount rates of 5% and 10%.

RESULTS: The 1,300 maternal deaths that occurred in Brazil in 2015 resulted in a total non-health GDP loss of US$ 268,830,673 and equates to US$ 206,793 per maternal death. The sensitivity analysis using discount rates of 5% and 10% resulted in total non-health GDP losses of US$ 196,917,206 and US$ 113,428,082, respectively. The indirect cost of maternal deaths represents a substantial loss to non-health GDP. These findings are similar to previous research in Africa, where losses in non-health GDP for upper middle income countries were estimated at US$ 283,355 (converted to 2015 prices) per maternal death, and across Latin America.

CONCLUSIONS: Estimates of indirect cost can be used in advocacy activities for increasing investment in maternity services and targeting maternal mortality rates through prevention strategies. Further research should be conducted to estimate the direct cost to society of maternal mortality.