COST-EFFECTIVENESS OF PLANNED BIRTH IN A BIRTH CENTRE COMPARED WITH PLANNED BIRTH IN A HOSPITAL AND AT HOME IN WOMEN AT LOW-RISK OF COMPLICATIONS

Purpose: To assess the costs and effects of planned birth under supervision of a community midwife in a birth centre, hospital and at home in women at low-risk of complications in the Netherlands.

Method(s):

The economic evaluation, performed from a health care perspective, took the form of a cost-effectiveness analysis in which the costs and effects were estimated for a planned birth in a birth centre (n=1668), hospital (n=701) and at home (n=1086). Separate analyses were performed for different types of birth centres, based on location and integration profile. The primary clinical outcomes were the optimality index (OI) a tool to measure ‘maximum outcome with minimal intervention’, containing both process and outcome items and a composite adverse outcome (CAO) score, which is a combined measure of adverse outcomes (including mortality and admission to the neonatal intensive care unit).

Multiple regression was used to estimate the differences in total cost and clinical outcomes and to adjust for potential confounders. Non-parametric bootstrapping was used to calculate uncertainty around all costs and effects estimates.

Result(s):

No clinically relevant differences in clinical outcomes were found between planned births in a birth centre, hospital and at home. Within the types of birth centres only the OI score of nulliparous women with a planned birth in a freestanding birth centre was clinical relevantly better (p<0.001) compared to a planned birth in an alongside birth centre. The total adjusted mean costs for births planned in a birth centre, hospital and at home were respectively €3326, €3330 and €2998. Focusing on the different types of birth centres, the total adjusted mean costs for births planned in a freestanding birth centre were €3531, alongside €3342 and on-site €3399 and costs ranged from €3283 to €3385 dependent on integration profile.

Conclusion(s):

There were no differences in costs and effects for women at low-risk of complications with a planned birth under supervision of a community midwife in a birth centre and in a hospital. For nulliparous and multiparous women at low-risk of complications, planned birth at home was the most cost-effective option compared to planned birth in a birth centre and in a hospital. There were no differences in costs and effects among the types of birth centres.