Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

Abstract

Objectives: To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres.

Design: Economic evaluation based on a prospective cohort study.

Setting: 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible.

Participants: 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013.

Main outcome measures: Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score.

Results: The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI).

Conclusions: We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.

Keywords: birth centre; economic evaluation; maternity care; optimality index.

Figure 1A and B

Mean cost (2015, €) and health outcomes (Optimality Index) of planned birth at a birth centre, hospital and at home under the supervision of a community midwife.

Figure 2A and B

Mean cost (2015, €) and health outcomes (composite adverse outcome score) of planned birth at a birth centre, hospital and at home under the supervision of a community midwife.

Figure 3

Cost-effectiveness acceptability curves, graphing the probability to be cost-effective for planned birth at the hospital and at home compared with the birth centre, for different values of the willingness to pay for an additional point on the Optimality Index.

Figure 4

Cost-effectiveness acceptability curves, graphing the probability to be cost-effective for planned birth in a freestanding, alongside and on-site birth centre, for different values of the willingness to pay for an additional point on the Optimality Index.

Figure 5

Cost-effectiveness acceptability curves, graphing the probability to be cost-effective for planned birth in a monodisciplinary-oriented birth centre, mixed group of birth centre and multidisciplinary-oriented birth centre, for different values of the willingness to pay for an additional point on the Optimality Index.