Cost effectiveness of alternative planned places of birth in woman at low risk of complications : evidence from the Birthplace in England national prospective cohort study
Schroeder, Elizabeth-Ann, Petrou, Stavros, Patel, Nishma, Hollowell, J. (Jennifer), Puddicombe, D., Redshaw, Margaret and Brocklehurst, Peter. (2012) Cost effectiveness of alternative planned places of birth in woman at low risk of complications : evidence from the Birthplace in England national prospective cohort study. BMJ, Vol.344 (No.3). e2292. ISSN 0959-535X
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Official URL: http://dx.doi.org/10.1136/bmj.e2292
Objectives To estimate the cost effectiveness of alternative planned places of birth.
Design Economic evaluation with individual level data from the Birthplace national prospective cohort study.
Setting 142 of 147 trusts providing home birth services, 53 of 56 freestanding midwifery units, 43 of 51 alongside midwifery units, and a random sample of 36 of 180 obstetric units, stratified by unit size and geographical region, in England, over varying periods of time within the study period 1 April 2008 to 30 April 2010.
Participants 64 538 women at low risk of complications before the onset of labour.
Interventions Planned birth in four alternative settings: at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units.
Main outcome measures Incremental cost per adverse perinatal outcome avoided, adverse maternal morbidity avoided, and additional normal birth. The non-parametric bootstrap method was used to generate net monetary benefits and construct cost effectiveness acceptability curves at alternative thresholds for cost effectiveness.
Results The total unadjusted mean costs were £1066, £1435, £1461, and £1631 for births planned at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units, respectively (equivalent to about €1274, $1701; €1715, $2290; €1747, $2332; and €1950, $2603). Overall, and for multiparous women, planned birth at home generated the greatest mean net benefit with a 100% probability of being the optimal setting across all thresholds of cost effectiveness when perinatal outcomes were considered. There was, however, an increased incidence of adverse perinatal outcome associated with planned birth at home in nulliparous low risk women, resulting in the probability of it being the most cost effective option at a cost effectiveness threshold of £20 000 declining to 0.63. With regards to maternal outcomes in nulliparous and multiparous women, planned birth at home generated the greatest mean net benefit with a 100% probability of being the optimal setting across all thresholds of cost effectiveness.
Conclusions For multiparous women at low risk of complications, planned birth at home was the most cost effective option. For nulliparous low risk women, planned birth at home is still likely to be the most cost effective option but is associated with an increase in adverse perinatal outcomes.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RG Gynecology and obstetrics|
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Childbirth at home -- Economic aspects, Childbirth -- Economic aspects|
|Journal or Publication Title:||BMJ|
|Publisher:||BMJ Publishing Group Ltd.|
|Official Date:||19 April 2012|
|Access rights to Published version:||Open Access|
|Funder:||Great Britain. Dept. of Health (DoH), National Institute for Health Research (Great Britain) (NIHR)|
|Grant number:||PB-PG-0107-12209 (NIHR)|
1 Campbell R, Macfarlane A. Where to be born? The debate and the evidence. 2nd ed.
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