Cost-effectiveness of Midwifery Services vs. Medical Services in Quebec

Reinharz, Daniel; Blais, Régis; Fraser, William D.; Contandriopoulos, André‐Pierre

doi:10.1007/bf03404261

Cited by 19 publications

(23 citation statements)

References 8 publications

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“…The cost ranges were very close and overlapped in the sensitivity analyses. This project was part of a series of seven pilot projects, summarized in this paper (23). Three of the pilot projects had results similar to those mentioned above, whereas four found no difference in costs.…”

Section: Resultsmentioning

confidence: 71%

“…Nine studies (reported in 10 papers) have considered the economic implications of birth centers (6,11,17–24). Three studies were economic evaluations based on randomized controlled trials (6,18,21), one (reported in two publications) was based on decision analytic modeling (19,20), and five were essentially costing studies (11,16,22–24). All studies were restricted to women at low risk of complications, although this was defined in different ways.…”

Section: Resultsmentioning

confidence: 99%

“…An observational study conducted in Canada examined the cost per delivery of midwifery services in a birth center compared with medical services in Quebec (23). In 1995 to 1996, 1,000 women were recruited to midwifery care and were matched, after delivery, according to several sociodemographic characteristics, with 1,000 women delivered in hospital.…”

Section: Resultsmentioning

confidence: 99%

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Economic Implications of Home Births and Birth Centers: A Structured Review

Henderson

Petrou

2008

Birth

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This review highlights the paucity of economic literature relating to home births and birth centers. Differences in results between studies may be attributed to differences in health care systems, differences in methods used, and differences in costs included. Further economic research that involves detailed bottom-up costing of alternative options for place of birth and measures multiple outcomes, including women's preferences, would help address the question of whether out-of-hospital birth is beneficial in economic terms.

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Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Economic Implications of Home Births and Birth Centers: A Structured Review

Henderson

Petrou

2008

Birth

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“…Although many studies show the positive outcomes of midwifery‐led maternity care, limited prior studies have documented the potential cost savings of changes to the financing and organization of maternity care services to increase access to midwifery care in the United States . Studies in other countries including the UK, Australia, and Canada have examined expenditures and cost‐effectiveness of midwifery care, but these studies vary in terms of the midwifery care model being analyzed and the comparison group . In addition, the health care financing and maternity care context in the United States is distinct, so the existing evidence is not easily applicable to health plan and policy discussions in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…[23][24][25][26] Studies in other countries including the UK, Australia, and Canada have examined expenditures and costeffectiveness of midwifery care, but these studies vary in terms of the midwifery care model being analyzed and the comparison group. [27][28][29][30][31][32][33] In addition, the health care financing and maternity care context in the United States is distinct, so the existing evidence is not easily applicable to health plan and policy discussions in the United States. Our objective was to compare the costs and outcomes of care for low-risk pregnancies with midwife-led care vs obstetrician-led care by using statistical models, built with existing published estimates and survey data.…”

mentioning

confidence: 99%

Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison

Attanasio

Alarid‐Escudero

Kozhimannil

2019

Birth

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Objective Low‐risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife‐led care vs obstetrician‐led care for low‐risk pregnancies using a decision‐analytic approach. Methods We developed a decision‐analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife‐led vs obstetrician‐led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011‐2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments. Results The costs of childbirth for low‐risk women with midwife‐led care were, on average, $2262 less than births to low‐risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife‐led care, compared with obstetrician‐led care. Across the population of US women with low‐risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife‐led vs obstetrician‐led care) and fewer episiotomies (170 504 vs 415 686, for midwife‐led vs obstetrician‐led care). Conclusions A shift from obstetrician‐led care to midwife‐led care for low‐risk pregnancies could be cost saving.

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