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Session: Maternal Health
Room: Main Hall
Time: Thu 14:30-15:45

Presenter: Nina Knape (University of Applied Sciences Osnabrueck. Faculty of Business Management and Social Sciences)

Abstract

Background
Increasing expenses in the social security system financed through contributions as well as a lack of evidence-based practice are obvious in the German health system. The legal framework therefore requires health economic studies.
Regarding maternal health, the caesarean rate is increasing rapidly in Germany from 18% in 1995 to 31,6% in 2008. According to the WHO, 10 to 15 % is an acceptable rate and the oversupply of c-sections seems to be an inappropriate (healthcare) service. Apart from detrimental health effects for women and children, rising intervention rates cause increasing costs. The concept of midwife-led care is discussed as an option to decrease these rates and to cause more continuity of care for low-risk women.
The potential of cost reduction is internationally disputed.
In order to support or fail the hypotheses of a positive cost-effectiveness and cost-benefit ratio of midwife-led care compared to consultant-led care, 1240 data records of women from four German hospitals were verified.

Methods
The cost-benefit and cost-effectiveness evaluation was piggy-back designed and was accompanied by a prospectively controlled multicentre trial comparing consultant-led and midwife-led care.
Costs were derived from activity-based-costing in the labour room. A time registration was designed to analyse labour costs for the different processes in the delivery ward.
Birth documentation was developed to register intervention and outcome parameter and to evaluate the expenditure in materials.
For cost-benefit analysis, women’s anticipations and preferences were obtained with a close-ended willingness-to-pay questionnaire (WTP) during pregnancy and eight weeks and six months postpartum. The WTP as well as the savings are defined as benefit.
The cost-effectiveness analysis considered cost and outcome parameters as morbidity of mothers and babies and the postnatal wellbeing (Edinburgh Postnatal Depression Scale) and health-related quality of life with SF-36 and EQ-5D.

Discussion
This economic evaluation is unique for Germany and incorporates different international research developments in maternity care of the last decade.
Data evaluation is in progress and results will be presented for the first time on an international congress.
Midwife-led care units may decrease costs and intervention rates. The focus is to obtain women’s opinion on alternatives in intrapartum care and their perception of decreasing intervention rates as well as more continuity in care. But as well as patients or societal perspective, the perspective of caregiver and health insurance companies should be considered.
The study strictly adhered to “Good Clinical Practice”.

BRAZIER, J., USHERWOOD, T., HARPER R., THOMAS, K.: Deriving a Preference-Based Single Index from the UK SF-36 Health Survey', Journal of clinical Epidemiology, vol. 51, no. 11, 1115- 1128, 1998
BUNDESGESCHÄFTSSTELLE QUALITÄTSSICHERUNG: BQS-Bundesauswertung 2008
Geburtshilfe. Düsseldorf, 2009
DONALDSON, Cam, HUNDLEY, Vanora, MAPP, Tracy: Willingness to pay: A method for measuring preferences for maternity care? In: Birth 25:3, 32-39, 1998
HATEM, Marie, SANDALL, Jane, DEVANE, Declan, SOLTANI, Hora, GATES, Simon: Midwife-led versus other models of care for childbearing women. Cochrane Review. In: The Cochrane Library, Issue 4. Chichester, UK: John Wiley & Sons, Ltd, 2008
WHO TECHNICAL WORKING GROUP: Safe Motherhood. Care in normal birth: a practical guide. Geneva 1996
www.euroqol.org

Key Terms

Maternity care, CBA, CEA, HRQol

Authors:

Nina Knape (University of Applied Sciences Osnabrueck. Faculty of Business Management and Social Sciences) , Rainhild Schaefers (University of Applied Sciences Osnabrueck. Faculty of Business Management and Social Sciences) and Manfred Haubrock (University of Applied Sciences Osnabrueck. Faculty of Business Management and Social Sciences)

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