A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital

J. Toohill, E. Turkstra, J. Gamble, P.A. Scuffham

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

Abstract

Objective to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). Design a prospective non-randomised trial. Setting an Australian metropolitan hospital. Method women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system. Main outcome measures: health-care costs to the hospital and government. Analysis generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. Findings women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. Conclusion for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable.
Original languageEnglish
Pages (from-to)e874-e879
Number of pages6
JournalMidwifery
Volume28
Issue number6
Early online date14 Dec 2011
DOIs
Publication statusPublished - 11 Dec 2012
Externally publishedYes

Keywords

  • Midwifery Group Practice
  • Birth centre
  • Cost-effectiveness
  • Continuity of carer

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