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Observational Study
. 2022 Mar 9;22(1):319.
doi: 10.1186/s12913-022-07709-9.

An observational cohort study of health outcomes and costs associated with early pregnancy assessment units in the UK

Edna Keeney  1 , Maria Memtsa  2 , Venetia Goodhart  2 , Davor Jurkovic  2 , Gareth Ambler  3 , Nazim Khan  4 , Jeff Round  5   6
Affiliations
Observational Study

An observational cohort study of health outcomes and costs associated with early pregnancy assessment units in the UK

Edna Keeney et al. BMC Health Serv Res. .

Abstract

Background: The objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations.

Methods: This was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety.

Results: Costs, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84-0.86) at baseline to 0.91 (95% CI 0.90-0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment.

Conclusions: EPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women's health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.

Keywords: Cohort study; Cost-effectiveness; Early pregnancy; Quality of life.

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Conflict of interest statement

EK reports personal fees from Novartis Pharmaceuticals UK Ltd. (London, UK), Roche Holding AG, and from Pfizer Inc. (Pfizer Inc., New York, NY, USA), outside the submitted work. JR is currently employed by the Institute of Health Economics. The Institute of Health Economics receives funding from, and collaborates with, government, academic, not-for-profit and private-sector organisations. The Institute of Health Economics does not currently receive funds for research related to the submitted work. MM, VG, DJ, GA and NK have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Change in anxiety pre and post consultation
See this image and copyright information in PMC

References

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