An assessment of the cost-effectiveness of midwife-led care in the United Kingdom

Abstract

Objectives: to analyse the existing evidence on the cost-effectiveness of midwife-led care compared with consultant-led care in settings potentially generalisable to the United Kingdom, and to estimate the potential cost savings accruing from an expansion of midwife-led care in the United Kingdom.

Design: a systematic review of the literature was conducted across twelve electronic databases for papers relating to the costs of midwife-led models of care. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies were considered for inclusion. The methods specified by the National Institute for Health and Clinical Excellence to assess the cost-effectiveness of midwife-led care were broadly used. Multiple simple one-way sensitivity analyses were undertaken to examine the robustness of findings to varying scenarios.

Findings: based on scant existing evidence, the mean cost saving for each eligible maternity was estimated at approximately ST£12.38 (sterling). If midwife-led services were expanded to 50% of all eligible women in the UK, as assumed in the main set of results, this would result in an aggregate cost saving of ST£1.16 million per year. In the sensitivity analyses, cost changes per maternity vary from a saving of ST£253.38 to a cost increase of ST£108.12 depending on the assumptions used, corresponding to aggregate savings of ST£23.75 million and a cost increase of ST£10.13 million.

Key conclusions: expanding midwife-led maternity services for eligible women may offer a means of reducing costs compared to the current leading model of care. However, firm conclusions are elusive due to the paucity of evidence.

Implications for practice: there is a clear need for further economic evaluations of models of maternity care in the United Kingdom context to guide the better use of scarce resources.