Economic evaluation of user-fee exemption policies for maternal healthcare in Burkina Faso : evidence from a cost-effectiveness analysis Nguyen, H. T. Torbica, A. Brenner, S. Kiendrebeogo, J. A. Tapsoba, L. /Ridde, Valéry De Allegri, M. Burkina Faso economic evaluation facility-based delivery maternal care user-fee exemptions Objectives: The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption inte rventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region. Methods: We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence. Results: Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted. Conclusions: Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries. 2020 text https://www.documentation.ird.fr/hor/fdi:010078897 fdi:010078897 Nguyen H. T., Torbica A., Brenner S., Kiendrebeogo J. A., Tapsoba L., Ridde Valéry, De Allegri M.. Economic evaluation of user-fee exemption policies for maternal healthcare in Burkina Faso : evidence from a cost-effectiveness analysis. 2020, 23 (3), 300-308 EN BURKINA FASO