Christopher Kenny1, Declan Devane2, Charles Normand3, Mike Clarke4, Aoife Howard5, Cecily Begley6. 1. RCSI Hospitals Group, 111 St Stephen׳s Green, Dublin 2, Ireland. Electronic address: cfo@rcsihospitals.ie. 2. National University of Ireland Galway and Saolta University Health Care Group, Ireland. Electronic address: declan.devane@nuigalway.ie. 3. Trinity College Dublin, Dublin 2, Ireland. Electronic address: normandc@tcd.ie. 4. The Queen׳s University of Belfast, Northern Ireland, UK. Electronic address: mclarke@qub.ac.uk. 5. Trinity College Dublin, Dublin 2, Ireland. 6. Trinity College Dublin, Dublin 2, Ireland. Electronic address: cbegley@tcd.ie.
Abstract
OBJECTIVE: to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. DESIGN: ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. SETTING: two maternity units in Ireland, with 'alongside' midwife-led units. PARTICIPANTS: all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks׳ gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. INTERVENTIONS: women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated ׳alongside׳ the consultant-led units, throughout pregnancy, birth and postnatal. MEASUREMENTS: mean difference in clinician salaries, cost of care based on managers׳ data, known costs of postnatal bed days and costs of key interventions were measured. FINDINGS: the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
RCT Entities:
OBJECTIVE: to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. DESIGN: ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. SETTING: two maternity units in Ireland, with 'alongside' midwife-led units. PARTICIPANTS: all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks׳ gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. INTERVENTIONS:women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated ׳alongside׳ the consultant-led units, throughout pregnancy, birth and postnatal. MEASUREMENTS: mean difference in clinician salaries, cost of care based on managers׳ data, known costs of postnatal bed days and costs of key interventions were measured. FINDINGS: the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
Authors: Christopher G Fawsitt; Jane Bourke; Aileen Murphy; Brendan McElroy; Jennifer E Lutomski; Rosemary Murphy; Richard A Greene Journal: Appl Health Econ Health Policy Date: 2017-12 Impact factor: 2.561
Authors: Luisa Masciullo; Luciano Petruzziello; Giuseppina Perrone; Francesco Pecorini; Caterina Remiddi; Paola Galoppi; Roberto Brunelli Journal: Int J Environ Res Public Health Date: 2020-06-29 Impact factor: 3.390