An exploratory cost-effectiveness analysis: Comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Belgium.
Midwifery
; 75: 117-126, 2019 Aug.
Article
em En
| MEDLINE
| ID: mdl-31100483
ABSTRACT
OBJECTIVE:
The objective of this study was to compare midwife-led and consultant-led obstetrical care for women with uncomplicated low-risk pregnancies. We estimated costs and maternal outcomes in both units to achieve a cost-effectiveness ratio.DESIGN:
The cost-analysis was made according to the "intention to treat" concept in order to minimize bias associated with the non-randomization of participants. At the obstetric-led unit, women received care from both midwives and medical staff while those in the alternative structure called 'Le Cocon' only received care from midwives.SETTING:
The obstetric-led unit of the Erasme University-Hospital in Brussels and its alongside midwife-led unit.PARTICIPANTS:
The study population included all low-risk pregnant women from 1 March 2014 until 31 October 2015 who were affiliated to the MLOZ (Mutualités Libres-Onafhankelijke Ziekenfondsen; third Belgian statutory health care insurer).INTERVENTIONS:
The cost calculation involved a bottom-up approach. The health care consumption of each participant was obtained from MLOZ's data. The study included costs occurred the beginning of pregnancy until 3 months post-partum. Clinical data were extracted from the patient medical records.FINDINGS:
Compared to the traditional obstetric-led unit, the alternative midwife-led unit was associated with a cost reduction for the national payer (∆ = -397.39, pâ¯=â¯0.046) and for the patient (∆ = - 44.19, pâ¯=â¯0.016). There were no significant differences in rates of caesarean, instrumental birth and epidural analgesia between MLU and OLU. A sensitivity analysis was performed (Appendix C) but does not change the overall results and conclusions. KEYCONCLUSIONS:
Due to the small size of the samples, no statistical differences were found. More analysis is needed to evaluate the cost-effectiveness regarding the use of epidural analgesia, caesarean and instrumental birth rates in the midwife-led unit. IMPLICATIONS FOR PRACTICE Given the economical findings, this could contribute to reduce health expenditures for both women (out of pocket) and state (public payer via health care insurers).Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Unidade Hospitalar de Ginecologia e Obstetrícia
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Padrões de Prática em Enfermagem
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Enfermeiros Obstétricos
Tipo de estudo:
Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Pregnancy
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article