902: A two-delivery model utilizing continuous support during labor: A cost-effectiveness analysis

Abstract

While doulas are professionals trained in providing continuous support during labor, many US women may instead choose to receive continuous support from relatives, friends, or community members with minimal training. In 2013 Hodnett et al. published a Cochrane review demonstrating that continuous presence of a layperson leads to fewer cesarean deliveries and shortened labor time. We sought to evaluate the cost-effectiveness and outcomes associated with this support on two subsequent deliveries. A cost-effectiveness model using TreeAge software was designed to compare outcomes in women with continuous support (from a relative, friend or community member with minimal training) during delivery vs. no continuous support. We used a theoretical cohort of 1.8 million women, the approximate number of nulliparous term births in the US annually. We considered these to be uncomplicated deliveries with a trial of labor and with all women having a second delivery, reflecting the average number of births per woman in the US. Outcomes included mode of delivery, maternal death, uterine rupture and hysterectomy, in addition to cost and quality-adjusted life years (QALY) for both pregnancies. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Sensitivity analyses were used to investigate the robustness of the results. Continuous support by a layperson during the first delivery resulted in fewer cesarean deliveries, reduced costs and improved QALYs for both the first and subsequent delivery. In our theoretical cohort, compared to no continuous support, women with a support person had 102,739 fewer cesarean deliveries, 24 fewer maternal deaths, 179 fewer uterine ruptures, and 47 fewer hysterectomies, saving $553 million with 3,382 increased QALYs (Table 1). Sensitivity analyses demonstrated that providing continuous support in the first delivery is cost-effective up to $673 in lost wages for the support person (Figure 1). Encouraging the use of continuous support throughout a woman’s delivery by a family member or friend with minimal to no training leads to fewer cesarean deliveries, improved outcomes, decreased costs and increased QALYs during her first and second delivery. These findings highlight the need to increase women’s access to continuous support during labor and delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)