Abstract
ObjectiveTo assess the cost-effectiveness of the use of cardiotocography (CTG) complemented with fetal electrocardiography and ST analysis compared with the use of CTG alone in term deliveries when a decision has been made to use fetal monitoring with a scalp electrode.DesignA cost-effectiveness analysis based on a probabilistic decision model incorporating relevant strategies and lifelong outcomes.SettingMaternity wards in Sweden.PopulationWomen with term fetuses after a clinical decision had been made to apply a fetal scalp electrode for internal CTG.MethodsA decision model was used to compare the costs and effects of two different treatment strategies. Baseline estimates were derived from the literature. Discounted costs and quality-adjusted life years (QALYs) were simulated over a lifetime horizon using a probabilistic model.Main outcome measuresQALYs, incremental costs, and cost per QALY gained expressed as incremental cost-effectiveness ratio (ICER).ResultsThe analysis found an incremental effect of 0.005 QALYs for ST analysis compared with CTG; the ST analysis strategy was also moreover associated with a €56 decrease in costs, thus dominating the CTG strategy. The probability that ST analysis is cost-effective in comparison with CTG is high, irrespective of the willingness-to-pay value for a QALY.ConclusionsCompared with CTG alone, ST analysis is cost-effective when used in term high-risk deliveries in which there is a need for internal fetal monitoring.
Highlights
Fetal oxygen deficiency during birth can cause neurological damage, and in 0.06%1 of all births in Sweden, the deficiency is so severe that it leads to cerebral palsy or death
To overcome some of these weaknesses and enhance the detection of fetuses at risk of hypoxia, a new method of combining CTG with ST analysis has been developed. This method provides an automatic analysis of the ST interval in the electrocardiogram complex of the a 2008 The Authors Journal compilation a RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
Even in the time period until just after delivery, ST analysis is cost saving in comparison with CTG alone (Table 5). This is explained by the lower rate of complicated deliveries, cases of metabolic acidosis, and cases of encephalopathy in the ST analysis arm
Summary
Fetal oxygen deficiency during birth can cause neurological damage, and in 0.06%1 of all births in Sweden, the deficiency is so severe that it leads to cerebral palsy or death. The most common method of fetal surveillance with a scalp electrode is internal cardiotocography (CTG) This method of surveillance, has been demonstrated to have several weaknesses and is coupled with blood sampling to achieve sufficient specificity.[1] To overcome some of these weaknesses and enhance the detection of fetuses at risk of hypoxia, a new method of combining CTG with ST analysis has been developed. This method provides an automatic analysis of the ST interval in the electrocardiogram complex of the a 2008 The Authors Journal compilation a RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
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