Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study.
Am J Obstet Gynecol
; 223(3): 431.e1-431.e18, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32112732
ABSTRACT
BACKGROUND:
Obstetric health care relies on an adequate antepartum risk selection. Most guidelines used for risk stratification, however, do not assess absolute risks. In 2017, a prediction tool was implemented in a Dutch region. This tool combines first trimester prediction models with obstetric care paths tailored to the individual risk profile, enabling risk-based care.OBJECTIVE:
To assess impact and cost-effectiveness of risk-based care compared to care-as-usual in a general population.METHODS:
A before-after study was conducted using 2 multicenter prospective cohorts. The first cohort (2013-2015) received care-as-usual; the second cohort (2017-2018) received risk-based care. Health outcomes were (1) a composite of adverse perinatal outcomes and (2) maternal quality-adjusted life-years. Costs were estimated using a health care perspective from conception to 6 weeks after the due date. Mean costs per woman, cost differences between the 2 groups, and incremental cost effectiveness ratios were calculated. Sensitivity analyses were performed to evaluate the robustness of the findings.RESULTS:
In total 3425 women were included. In nulliparous women there was a significant reduction of perinatal adverse outcomes among the risk-based care group (adjusted odds ratio, 0.56; 95% confidence interval, 0.32-0.94), but not in multiparous women. Mean costs per pregnant woman were significantly lower for risk-based care (mean difference, -2766; 95% confidence interval, -3700 to -1825). No differences in maternal quality of life, adjusted for baseline health, were observed.CONCLUSION:
In the Netherlands, risk-based care in nulliparous women was associated with improved perinatal outcomes as compared to care-as-usual. Furthermore, risk-based care was cost-effective compared to care-as-usual and resulted in lower health care costs.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cuidado Pré-Natal
/
Padrões de Prática Médica
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Obstetrícia
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Health_economic_evaluation
/
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Female
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Humans
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Middle aged
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Pregnancy
País/Região como assunto:
Europa
Idioma:
En
Revista:
Am J Obstet Gynecol
Ano de publicação:
2020
Tipo de documento:
Article