Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial

Abstract

Objectiveto investigate the cost-effectiveness in birth care for low-risk women, in an alongside midwife-led unit (MU) compared to a standard obstetric unit (SCU) within the same hospital. Designeconomic evaluation based on the findings of a randomised trial, randomising participants either into the MU or SCU. The hospital's activity-based costing system CPP was used to estimate costs, as no data on complete resource use exists. Settingthe Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. Participantsthe study population consists of 1,110 consenting healthy women, assessed to be at low-risk at spontaneous onset of labour. Measurementseffect measures; avoided caesarean sections, instrumental vaginal deliveries, complications requiring treatment in the operating room, epidural analgesia and oxytocin augmentation. Costs (€) were calculated by costs per day multiplied with length of stay, added costs for procedures performed outside the units. The results are expressed in incremental cost-effectiveness ratios (ICER) with SCU as comparator. Findingstotal costs per stay were significantly lower for women at the MU (€1,672) compared to the SCU (€1,950, p<0.001). The ICER showed that MU was a dominant strategy (lower costs and reduction in clinical procedures) for all effect measures. Based on the sensitivity analysis, allocating low-risk women to MU significantly reduced costs, but was not a dominant strategy for all outcomes. Key conclusionsthe MU is more cost-effective than the SCU for low-risk women without prelabour preference for level of birth care provided equal capacity at the units. Implications for practiceit is cost-effective to organise birth care for low-risk women in a separate midwife-led unit.