Nguyen H. T. auteur aut IRD Torbica A. auteur aut IRD Brenner S. auteur aut IRD Kiendrebeogo J. A. auteur aut IRD Tapsoba L. auteur aut IRD Ridde Valéry auteur aut IRD De Allegri M. auteur aut IRD text journalArticle eng text/pdf born digital access 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. specialized Burkina Faso economic evaluation facility-based delivery maternal care user-fee exemptions BURKINA FASO 056 23 3 300-308 2020 1098-3015 https://www.documentation.ird.fr/hor/fdi:010078897 10.1016/j.jval.2019.10.007 1098-3015 [F B010078897] https://www.documentation.ird.fr/hor/fdi:010078897 https://www.documentation.ird.fr/intranet/publi/2020/04/010078897.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2020-05-19 2025-02-24 fdi:010078897 fre