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. 2020 Sep;223(3):431.e1-431.e18.
doi: 10.1016/j.ajog.2020.02.036. Epub 2020 Feb 26.

Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study

Pim van Montfort  1 , Hubertina C J Scheepers  2 , Carmen D Dirksen  3 , Ivo M A van Dooren  4 , Sander M J van Kuijk  3 , Linda J E Meertens  5 , Ella J Wijnen  6 , Maartje Zelis  7 , Iris M Zwaan  8 , Marc E A Spaanderman  2 , Luc J M Smits  5
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Free article

Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study

Pim van Montfort et al. Am J Obstet Gynecol. 2020 Sep.
Free article

Abstract

Background: Obstetric health care relies on an adequate antepartum risk selection. Most guidelines used for risk stratification, however, do not assess absolute risks. In 2017, a prediction tool was implemented in a Dutch region. This tool combines first trimester prediction models with obstetric care paths tailored to the individual risk profile, enabling risk-based care.

Objective: To assess impact and cost-effectiveness of risk-based care compared to care-as-usual in a general population.

Methods: A before-after study was conducted using 2 multicenter prospective cohorts. The first cohort (2013-2015) received care-as-usual; the second cohort (2017-2018) received risk-based care. Health outcomes were (1) a composite of adverse perinatal outcomes and (2) maternal quality-adjusted life-years. Costs were estimated using a health care perspective from conception to 6 weeks after the due date. Mean costs per woman, cost differences between the 2 groups, and incremental cost effectiveness ratios were calculated. Sensitivity analyses were performed to evaluate the robustness of the findings.

Results: In total 3425 women were included. In nulliparous women there was a significant reduction of perinatal adverse outcomes among the risk-based care group (adjusted odds ratio, 0.56; 95% confidence interval, 0.32-0.94), but not in multiparous women. Mean costs per pregnant woman were significantly lower for risk-based care (mean difference, -€2766; 95% confidence interval, -€3700 to -€1825). No differences in maternal quality of life, adjusted for baseline health, were observed.

Conclusion: In the Netherlands, risk-based care in nulliparous women was associated with improved perinatal outcomes as compared to care-as-usual. Furthermore, risk-based care was cost-effective compared to care-as-usual and resulted in lower health care costs.

Keywords: cost-effectiveness; implementation; perinatal outcomes; prediction; pregnancy; quality of life.

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