A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies.

Christopher Wai Hung Yau,Tim Draycott,Erik Lenguerrand,Steve Morris,Elena Pizzo,Aduragbemi Banke-Thomas

doi:10.1371/journal.pone.0249031

Abstract

ObjectiveTo determine the cost-utility of a multi-professional simulation training programme for obstetric emergencies–Practical Obstetric Multi-Professional Training (PROMPT)–with a particular focus on its impact on permanent obstetric brachial plexus injuries (OBPIs).DesignA model-based cost-utility analysis.SettingMaternity units in England.PopulationSimulated cohorts of individuals affected by permanent OBPIs.MethodsA decision tree model was developed to estimate the cost-utility of adopting annual, PROMPT training (scenario 1a) or standalone shoulder dystocia training (scenario 1b) in all maternity units in England compared to current practice, where only a proportion of English units use the training programme (scenario 2). The time horizon was 30 years and the analysis was conducted from an English National Health Service (NHS) and Personal Social Services perspective. A probabilistic sensitivity analysis was performed to account for uncertainties in the model parameters.Main outcome measuresOutcomes for the entire simulated period included the following: total costs for PROMPT or shoulder dystocia training (including costs of OBPIs), number of OBPIs averted, number of affected adult/parental/dyadic quality adjusted life years (QALYs) gained and the incremental cost per QALY gained.ResultsNationwide PROMPT or shoulder dystocia training conferred significant savings (in excess of £1 billion ($1.5 billion)) compared to current practice, resulting in cost-savings of at least £1 million ($1.5 million) per any type of QALY gained. The probabilistic sensitivity analysis demonstrated similar findings.ConclusionIn this model, national implementation of multi-professional simulation training for obstetric emergencies (or standalone shoulder dystocia training) in England appeared to both be cost-saving when evaluating their impact on permanent OBPIs.

Highlights

Shoulder dystocia is an obstetric emergency and occurs when the anterior shoulder of a baby is impacted against the mother’s pelvic bone during birth [1]
A decision tree model was developed to estimate the cost-utility of adopting annual, Practical Obstetric Multi-Professional Training (PROMPT) training or standalone shoulder dystocia training in all maternity units in England compared to current practice, where only a proportion of English units use the training programme
A total 1,753 permanent obstetric brachial plexus injuries (OBPIs) were avoided when opting for nationwide PROMPT or national shoulder

Summary

Introduction

Shoulder dystocia is an obstetric emergency and occurs when the anterior shoulder of a baby is impacted against the mother’s pelvic bone during birth [1]. Practical Obstetric Multi-Professional Training (PROMPT) was developed in the UK by a multidisciplinary maternity team to provide simulation training for a wide range of obstetric emergencies such as shoulder dystocia, maternal sepsis and eclampsia [10]. It consists of a ‘Course in a Box’, which contains course and trainer manuals, and adaptable training materials for local use. The implementation of PROMPT has been associated with clinical improvements [11,12,13,14], including the eradication of permanent OBPIs [15], and is recognised as a leading example of local multi-professional training for obstetric emergencies [8]

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Conclusion