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

Objective: to 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.

Design: economic 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.

Setting: the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway.

Participants: the study population consists of 1,110 consenting healthy women, assessed to be at low-risk at spontaneous onset of labour.

Measurements: effect 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.

Findings: total 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 conclusions: the 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 practice: it is cost-effective to organise birth care for low-risk women in a separate midwife-led unit.