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Callander EJ, Bick D, Mistry H. Designing economic evaluations alongside clinical trials in maternal health care: A guide for clinical trial design. Birth 2024; 51:405-412. [PMID: 37921334 DOI: 10.1111/birt.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines. METHODS This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia. RESULTS There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs. DISCUSSION This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health.
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Affiliation(s)
- Emily J Callander
- School of Public Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Debra Bick
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hema Mistry
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Hu Y, Gamble J, Allen J, Creedy DK, Toohill J, Callander E. A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia. Midwifery 2024; 133:103998. [PMID: 38615374 DOI: 10.1016/j.midw.2024.103998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system. METHODS We created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031. Woman and infant health service costs (inpatient, outpatient and emergency department) during pregnancy and birth were summed. The base model represented current standard maternity care and a counterfactual model represented two hypothetical scenarios where 50 % or 65 % of women giving birth would access continuity of midwifery carer. Costs were reported in 2021/22 AUD. RESULTS The estimated cost savings to Queensland public hospital funders per pregnancy were $336 in 2023/24 and $546 with 50 % access. With 65 % access, the cost savings were estimated to be $534 per pregnancy in 2023/24 and $839 in 2030/31. A total State-level annual cost saving of $12 million in 2023/24 and $19 million in 2030/31 was estimated with 50 % access. With 65 % access, total State-level annual cost savings were estimated to be $19 million in 2023/24 and $30 million in 2030/31. CONCLUSION Enabling most childbearing women in Australia to access continuity of midwifery carer would realise significant cost savings for the public health care system by reducing the rate of operative birth.
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Affiliation(s)
- Yanan Hu
- Faculty of Medicine, Monash Centre for Health Research and Implementation, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jenny Gamble
- Research Centre for Healthcare and Communities, Coventry University, Coventry, United Kingdom; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jyai Allen
- Faculty of Medicine, Monash Centre for Health Research and Implementation, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jocelyn Toohill
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, Australia.
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Callander EJ, Tarnow-Mordi W, Morton R, Mol BW, Kumar S. Intrapartum use of sildenafil citrate to prevent fetal compromise and emergency operative birth in term pregnancies in the United Kingdom and Australia: A preliminary cost-effectiveness analysis. Int J Gynaecol Obstet 2024; 164:1010-1018. [PMID: 37723993 DOI: 10.1002/ijgo.15135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To compare cost-effectiveness of oral sildenafil citrate, administered after onset of labor, with standard care to health system funders in the UK and Australia. METHODS We conducted a modeled cost-effectiveness analysis, measuring costs and quality adjusted life years (QALYs), using a decision-analytic model covering onset of labor to 1 month post-birth. The relative risk of emergency cesarean section and operative vaginal birth was taken from a Phase 2 placebo controlled double blinded randomized control trial. RESULTS Both options of care resulted in the same QALYs gained over the model time period (0.08). Sildenafil citrate was cost-saving compared with standard care, saving £92 per birth in the UK (AU$303 per birth in Australia). Sensitivity analyses did not identify any areas of uncertainty that stopped sildenafil citrate being cost saving compared with standard care. Threshold analysis revealed that sildenafil citrate would be cost saving up to a per birth drug or administration cost of £152.32 in the UK (AU$333.61 in Australia). CONCLUSION Oral sildenafil citrate may be cost saving compared with standard care; however, the effects on neonatal outcomes still need to be demonstrated in large randomized trials.
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Affiliation(s)
- Emily J Callander
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Sailesh Kumar
- Mater Research Institute and Mayne Academy, University of Queensland, Brisbane, Queensland, Australia
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Hu Y, Allen J, Ellwood D, Slavin V, Gamble J, Toohill J, Callander E. The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia. Women Birth 2024; 37:137-143. [PMID: 37524616 DOI: 10.1016/j.wombi.2023.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. OBJECTIVE This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. METHODS We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. RESULTS In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). CONCLUSION A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jyai Allen
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - David Ellwood
- School of Medicine & Dentistry, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia
| | - Valerie Slavin
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom
| | - Jocelyn Toohill
- School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom; Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Martin E, Ayoub B, Miller YD. A systematic review of the cost-effectiveness of maternity models of care. BMC Pregnancy Childbirth 2023; 23:859. [PMID: 38093244 PMCID: PMC10717830 DOI: 10.1186/s12884-023-06180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES In this systematic review, we aimed to identify the full extent of cost-effectiveness evidence available for evaluating alternative Maternity Models of Care (MMC) and to summarize findings narratively. METHODS Articles that included a decision tree or state-based (Markov) model to explore the cost-effectiveness of an MMC, and at least one comparator MMC, were identified from a systematic literature review. The MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases were searched for papers published in English, Arabic, and French. A narrative synthesis was conducted to analyse results. RESULTS Three studies were included; all using cost-effectiveness decision tree models with data sourced from a combination of trials, databases, and the literature. Study quality was fair to poor. Each study compared midwife-led or doula-assisted care to obstetrician- or physician-led care. The findings from these studies indicate that midwife and doula led MMCs may provide value. CONCLUSION The findings of these studies indicate weak evidence that midwife and doula models of care may be a cost-effective or cost-saving alternative to standard care. However, the poor quality of evidence, lack of standardised MMC classifications, and the dearth of research conducted in this area are barriers to conclusive evaluation and highlight the need for more research incorporating appropriate models and population diversity.
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Affiliation(s)
- Elizabeth Martin
- Wesley Research Institute, Auchenflower, Qld, Australia.
- Mater Research Institute - University of Queensland, South Brisbane, Qld, Australia.
| | - Bassel Ayoub
- School of Public Health and Social Work, Faculty of Health, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia
| | - Yvette D Miller
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
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Callander EJ, Enticott JC, Eklom B, Gamble J, Teede HJ. The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study. Med J Aust 2023; 219:535-541. [PMID: 37940105 PMCID: PMC10952409 DOI: 10.5694/mja2.52156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/18/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To quantify the value of maternity health care - the relationship of outcomes to costs - in Queensland during 2012-18. STUDY DESIGN Retrospective observational study; analysis of Queensland Perinatal Data Collection data linked with the Queensland Health Admitted Patient, Non-Admitted Patient, and Emergency Data Collections, and with the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) databases. SETTING, PARTICIPANTS All births in Queensland during 1 July 2012 - 30 June 2018. MAIN OUTCOME MEASURES Maternity care costs per birth (reported in 2021-22 Australian dollars), both overall and by funder type (public hospital funders, MBS, PBS, private health insurers, out-of-pocket costs); value of care, defined as total cost per positive birth outcome (composite measure). RESULTS The mean cost per birth (all funders) increased from $20 471 (standard deviation [SD], $17 513) during the second half of 2012 to $30 000 (SD, $22 323) during the first half of 2018; the annual total costs for all births increased from $1.31 billion to $1.84 billion, despite a slight decline in the total number of births. In a mixed effects linear analysis adjusted for demographic, clinical, and birth characteristics, the mean total cost per birth in the second half of 2018 was $9493 higher (99.9% confidence interval, $8930-10 056) than during the first half of 2012. The proportion of births that did not satisfy our criteria for a positive birth outcome increased from 27.1% (8404 births) during the second half of 2012 to 30.5% (9041 births) during the first half of 2018. CONCLUSION The costs of maternity care have increased in Queensland, and many adverse birth outcomes have become more frequent. Broad clinical collaboration, effective prevention and treatment strategies, as well as maternal health services focused on all dimensions of value, are needed to ensure the quality and viability of maternity care in Australia.
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Affiliation(s)
| | - Joanne C Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
| | | | | | - Helena J Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
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Chen AX, Hunt RW, Palmer KR, Bull CF, Callander EJ. The impact of assisted reproductive technology and ovulation induction on breech presentation: A whole of population‐based cohort study. Aust N Z J Obstet Gynaecol 2023. [DOI: 10.1111/ajo.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
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Callander EJ, Teede H, Enticott J. Value in maternal care: Using the Learning Health System to facilitate action. Birth 2022; 49:589-594. [PMID: 36265164 PMCID: PMC9828125 DOI: 10.1111/birt.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
There is an increasing need to deliver high-value health care. Here, we discuss how value should be measured and implemented in maternity care through a Learning Health System. High-value maternity care will produce the highest level of benefit for women at a given cost. As pregnancy is not an illness state, and there is no cure or remission to be achieved, we believe that patient-reported outcomes should be an integral component of benefit quantification when measuring value. Furthermore, as care impacts more than just health outcomes-particularly in maternity care-there is also a need to consider patient-reported experiences as a part of defining the level of benefit. However, to move beyond traditional narrow and passive measurement of value, we need to partner with stakeholders to identify priorities for change, identify evidence for how to achieve this change, integrate measurement activities, and promote effective implementation, in a continuous, learning cycle-a Learning Health System. A robust Framework for implementing a Learning Health System has been developed, which could be applied in maternity care.
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Affiliation(s)
- Emily J. Callander
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
| | - Helena Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
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Callander EJ, Andrews C, Sketcher-Baker K, Nicholl MC, Farrell T, Karger S, Flenady V. Safer Baby Bundle: study protocol for the economic evaluation of a quality improvement initiative to reduce stillbirths. BMJ Open 2022; 12:e058988. [PMID: 36038179 PMCID: PMC9438048 DOI: 10.1136/bmjopen-2021-058988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Stillbirth continues to be a public health concern in high-income countries, and with mixed results from several stillbirth prevention interventions worldwide the need for an effective prevention method is ever present. The Safer Baby Bundle (SBB) proposes five evidence-based care packages shown to reduce stillbirth when implemented individually, and therefore are anticipated to produce significantly better outcomes if grouped together. This protocol describes the planned economic evaluation of the SBB quality improvement initiative in Australia. METHODS AND ANALYSIS The implementation of the SBB will occur over three state-based health jurisdictions in Australia-New South Wales, Queensland and Victoria, from July 2019 onwards. The intervention is being applied at the state level, with sites opting to participate or not, and no individual woman recruitment. The economic evaluation will be based on a whole-of-population linked administrative dataset, which will include the data of all mothers, and their resultant children, who gave birth between 1 January 2016 and 31 December 2023 in these states, covering the preimplementation and postimplementation time period. The primary health outcome for this economic evaluation is late gestation stillbirths, with the secondary outcomes including but not limited to neonatal death, gestation at birth, mode of birth, admission to special care nursery and neonatal intensive care unit, and physical and mental health conditions for mother and child. Costs associated with all healthcare use from birth to 5 years post partum will be included for all women and children. A cost-effectiveness analysis will be undertaken using a difference-in-difference analysis approach to compare the primary outcome (late gestation stillbirth) and total costs for women before and after the implementation of the bundle. ETHICS AND DISSEMINATION Ethics approval for the SBB project was provided by the Royal Brisbane & Women's Hospital Human Research Ethics Committee (approval number: HREC/2019/QRBW/47709). Approval for the extraction of data to be used for the economic evaluation was granted by the New South Wales Population and Health Services Research Ethics Committee (approval number: 2020/ETH00684/2020.11), Australian Institute of Health and Welfare Human Research Ethics Committee (approval number: EO2020/4/1167), and Public Health Approval (approval number: PHA 20.00684) was also granted. Dissemination will occur via publication in peer reviewed journals, presentation at clinical and policy-focused conferences and meetings, and through the authors' clinical and policy networks.This study will provide evidence around the cost effectiveness of a quality improvement initiative to prevent stillbirth, identifying the impact on health service use during pregnancy and long-term health service use of children.
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Affiliation(s)
- Emily Joy Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Saint Lucia, Queensland, Australia
| | | | - Michael Christopher Nicholl
- Health and Social Policy Branch, New South Wales Ministry of Health, St Leonards, New South Wales, Australia
- Department of Obstetrics and Gynaecology, University of Sydney, Sydney, New South Wales, Australia
| | - Tanya Farrell
- Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Shae Karger
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Bull C, Howie P, Callander EJ. Inequities in vulnerable children’s access to health services in Australia. BMJ Glob Health 2022; 7:bmjgh-2021-007961. [PMID: 35346955 PMCID: PMC8961130 DOI: 10.1136/bmjgh-2021-007961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Children born into families at risk of becoming or remaining poor are at significant risk of experiencing childhood poverty, which can impair their start to life, and perpetuate intergenerational cycles of poverty. This study sought to quantify health service utilisation, costs and funding distribution amongst children born into vulnerable compared to non-vulnerable families. Methods This study used a large linked administrative dataset for all women giving birth in Queensland, Australia between July 2012 and July 2018. Health service use included inpatient, emergency department (ED), general practice, specialist, pathology and diagnostic imaging services. Costs included those paid by public hospital funders, private health insurers, Medicare and out-of-pocket costs. Results Vulnerable children comprised 34.1% of the study cohort. Compared with non-vulnerable children, they used significantly higher average numbers of ED services during the first 5 years of life (2.52±3.63 vs 1.97±2.77), and significantly lower average numbers of specialist, pathology and diagnostic imaging services. Vulnerable children incurred significantly greater costs to public hospital funders compared with non-vulnerable children over the first 5 years of life ($16 053 vs $10 247), and significantly lower private health insurer, Medicare and out-of-pocket costs. Conclusion There are clear inequities in vulnerable children’s health service utilisation in Australia. Greater examination of the uptake and cost-effectiveness of maternal and child services is needed, as these services support children’s development in the critical first 1000 days of life.
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Affiliation(s)
- Claudia Bull
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peta Howie
- Child & Youth Community Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Emily J Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Callander E, Bull C, Forster D. Using epidemiological and health economic measures to inform maternity staffing decisions: A guide. Women Birth 2021; 35:e471-e476. [PMID: 34953751 DOI: 10.1016/j.wombi.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is growing concern around unnecessary intervention (particularly caesarean section) at birth in high-income countries. Caseload midwifery care aims to offset this, but is perceived to be costly to health services. AIM To use epidemiological and health economic techniques to estimate health outcomes and cost-savings of different levels of equivalent full time (EFT) midwives working in caseload midwifery care. METHODS Two simulations were conducted - one assuming 10 EFT midwives working in a caseload model, with 35 women per caseload, and one assuming 50 EFT midwives working in a caseload model, with 45 women per caseload. Both were based on a sample of 5000 women. The main model inputs included rates of health outcomes for women (caesarean section, epidural anaesthesia, and episiotomy) and infants (low birthweight and admissions to special care nursery (SCN) or neonatal intensive care unit (NICU)), and the cost savings associated with health outcome avoidance. FINDINGS The first simulation estimated 27 fewer caesarean sections, 12 fewer epidurals, 12 fewer episiotomies, 10 fewer low birthweight births, and 23 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$1,874,715. The second simulation estimated 173 fewer caesarean sections, 76 fewer epidurals, 76 fewer episiotomies, 65 fewer low birthweight births, and 150 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$12,051,741. CONCLUSION This study provides local-level decision-makers with a decision-tool to calculate the potentially avoidable health outcomes and cost savings associated with implementing caseload midwifery care in their own service.
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Affiliation(s)
- Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Australia; Royal Women's Hospital, Melbourne, Australia
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Bull C, Ellwood D, Toohill J, Rigney A, Callander EJ. Quantifying the differences in birth outcomes and out-of-pocket costs between Australian Defence Force servicewomen and civilian women: A data linkage study. Women Birth 2021; 35:e432-e438. [PMID: 34802938 DOI: 10.1016/j.wombi.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Servicewomen in Defence Forces the world over are constrained in their health service use by defence healthcare policy. These policies govern a woman's ability to choose who she receives maternity care from and where. The aim of this study was to compare Australian Defence Force (ADF) servicewomen and children's birth outcomes, health service use, and out-of-pocket costs to those of civilian women and children. METHODS Retrospective cohort study using linked administrative data for women giving birth between 1 July 2012 and 30 June 2018 in Queensland, Australia (n = 365,138 births). Women serving in the ADF at the time of birth were identified as having their care funded by the Department of Defence (n = 395 births). Propensity score matching was used to identify a mixed public/private civilian sample of women to allow for comparison with servicewomen, controlling for baseline characteristics. Sensitivity analysis was also conducted using a sample of civilian women accessing only private maternity care. FINDINGS Nearly all servicewomen gave birth in the private setting (97.22%). They had significantly greater odds of having a caesarean section (OR 1.71, 95%CI 1.29-2.30) and epidural (OR 1.56, 95%CI 1.11-2.20), and significantly lower odds of having a non-instrumental vaginal birth (OR 0.57, 95%CI 0.43-0.75) compared to women in the matched public/private civilian sample. Compared to civilian children, children born to servicewomen had significantly higher out-of-pocket costs at birth ($275.93 ± 355.82), in the first ($214.98 ± 403.45) and second ($127.75 ± 391.13) years of life, and overall up to two years of age ($618.66 ± 779.67) despite similar health service use. CONCLUSIONS ADF servicewomen have higher rates of obstetric intervention at birth and also pay significantly higher out-of-pocket costs for their children's health service utilisation up to 2-years of age. Given the high rates of obstetric intervention, greater exploration of servicewomen's maternity care experiences and preferences is warranted, as this may necessitate further reform to ADF maternity healthcare policy.
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Affiliation(s)
- Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| | - David Ellwood
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, 4222, Australia
| | - Jocelyn Toohill
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, 4222, Australia; Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, 4006, Australia. https://www.twitter.com/JocelynToohill
| | - Azure Rigney
- Maternity Choices Australia, Springwood, Queensland, 4127, Australia. https://www.twitter.com/AzureRigney
| | - Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia. https://www.twitter.com/EmilyCallander
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Eklom B, Tracy S, Callander E. An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia. BMC Pregnancy Childbirth 2021; 21:703. [PMID: 34666718 PMCID: PMC8524906 DOI: 10.1186/s12884-021-04181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult. The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care. Methods This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services. Results There are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure. Conclusions Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.
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Affiliation(s)
- Bonnie Eklom
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia. .,The School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Sally Tracy
- The Molly Wardaguga Research Centre, Charles Darwin University, Darwin, NT, Australia.,The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2050, Australia
| | - Emily Callander
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia.,The School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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Callander EJ, Bull C, Baird K, Branjerdporn G, Gillespie K, Creedy D. Cost of intimate partner violence during pregnancy and postpartum to health services: a data linkage study in Queensland, Australia. Arch Womens Ment Health 2021; 24:773-779. [PMID: 33856553 DOI: 10.1007/s00737-021-01130-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/03/2021] [Indexed: 11/27/2022]
Abstract
To quantify health service costs of intimate partner violence (IPV) during pregnancy and postpartum; and to compare health service costs between women who reported IPV, versus women who did not report IPV. This was a cohort study using linked data for a publicly funded Australian tertiary hospital maternity service. Participants included all women accessing antenatal services between August 2016 and August 2018. Routinely collected IPV data were linked to women's admitted, non-admitted, emergency department, perinatal, and costing data from 6 months prior to reporting IPV through to 12 months post-birth. Of the 9889 women receiving maternity care, 280 (2.9%) reported some form of IPV with 72 (24.8%) referred to support. Women who reported IPV generated higher mean total costs than women not reporting IPV ($12,772 vs $10,166, respectively). Between-group differences were significant after adjusting for demographic and clinical factors (cost ratio 1.24, 95% CI: 1.15-1.34). There were no significant differences in mean total costs for babies where IPV was and was not reported ($4971 vs $5340, respectively). IPV is costly for health services. However, greater research is needed to comprehensively estimate the long-term health service costs associated with IPV. Furthermore, the limitations associated with routinely collected IPV data suggest that standardised screening practices and innovative data linkage and modelling approaches are required to collect data that truly represents the burden and costs associated with IPV.
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Affiliation(s)
- Emily J Callander
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia. .,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, 3181, VIC, Australia.
| | - Claudia Bull
- School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia
| | - Kathleen Baird
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, 2007, NSW, Australia
| | | | - Kerri Gillespie
- Gold Coast Hospital and Health Service, Southport, 4215, QLD, Australia
| | - Debra Creedy
- Transforming Maternity Care Collaborative, Griffith University, Southport, 4215, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, 4215, QLD, Australia
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Callander EJ, Gamble J, Creedy DK. Postnatal Major Depressive Disorder in Australia: Inequalities and Costs of Healthcare to Individuals, Governments and Insurers. PHARMACOECONOMICS 2021; 39:731-739. [PMID: 33682021 DOI: 10.1007/s40273-021-01013-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Perinatal mental health has pervasive impacts on the wellbeing of both the mother and child, affecting quality of life, bonding and attachment and cognitive development. OBJECTIVES The aim of this study was to (i) quantify the costs to government healthcare funders, private health insurers and individuals through out-of-pocket fees, of women with postnatal major depressive disorder (MDD); and (ii) identify any socioeconomic inequalities in health service use and costs amongst these women. METHODS A whole-of-population linked administrative dataset containing the clinical records and health service use for all births in the state of Queensland, Australia between 01 July 2012 and 30 June 2015 was used (n = 189,081). Postnatal MDD was classified according to ICD-10 code, with women hospitalised for MDD in the 12 months after birth classified as having 'postnatal MDD' (n = 728). Health service use and costs from birth to 12 months post-birth were included. Total costs included cost to government funders and private health insurers and out-of-pocket fees. Total costs and costs to different funders were compared for women with postnatal MDD and for women without an inpatient event for postnatal MDD, with unadjusted means presented. A generalised linear model was used to compare the difference in total costs, adjusting for key confounders. Costs to different funders and number of different services accessed were then compared for women with postnatal MDD by socioeconomic status, with unadjusted means presented. RESULTS The total costs from birth to 12 months post-birth were 636% higher for women with postnatal MDD than women without an inpatient event for postnatal MDD, after accounting for differences in private hospital use, mode of birth, clinical characteristics and socioeconomic status. Amongst women with postnatal MDD, the cost of all services accessed was higher for women of highest socioeconomic status than for women of lowest socioeconomic status (A$15,787.66 vs A$11,916.94). The cost of services for women of highest socioeconomic status was higher for private health insurers (A$8941.25 vs A$2555.26), but lower for public hospital funders (A$2423.39 vs A$6582.09) relative to women of lowest socioeconomic status. Outside of public hospitals, costs to government funders was higher for women of highest socioeconomic status (A$2766.80 vs A$1952.00). Women of highest socioeconomic status accessed more inpatient (8.2 vs 3.1) and specialist services (13.4 vs 5.5) and a higher proportion had access to psychiatric specialist care (39.7% vs 13.6%) and antidepressants (97.6% vs 93.8%). CONCLUSION MDD is costly to all funders of healthcare. Amongst women with MDD, there are large differences in the types of services accessed and costs to different funders based on socioeconomic status. There may be significant financial and structural barriers preventing equal access to care for women with postnatal MDD.
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Affiliation(s)
- Emily J Callander
- Transforming Maternity Care Collaborative, Meadowbrook, QLD, Australia.
- School of Public Health and Preventive Medicine, 553 St Kilda Rd, Melbourne, VIC, 3181, Australia.
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia.
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, Meadowbrook, QLD, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Debra K Creedy
- Transforming Maternity Care Collaborative, Meadowbrook, QLD, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
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Carson LE, Azmi B, Jewell A, Taylor CL, Flynn A, Gill C, Broadbent M, Howard L, Stewart R, Poston L. Cohort profile: the eLIXIR Partnership-a maternity-child data linkage for life course research in South London, UK. BMJ Open 2020; 10:e039583. [PMID: 33028561 PMCID: PMC7539583 DOI: 10.1136/bmjopen-2020-039583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Linked maternity, neonatal and maternal mental health records were created to support research into the early life origins of physical and mental health, in mothers and children. The Early Life Cross Linkage in Research (eLIXIR) Partnership was developed in 2018, generating a repository of real-time, pseudonymised, structured data derived from the electronic health record systems of two acute and one Mental Health Care National Health Service (NHS) Provider in South London. We present early descriptive data for the linkage database and the robust data security and governance structures, and describe the intended expansion of the database from its original development. Additionally, we report details of the accompanying eLIXIR Research Tissue Bank of maternal and neonatal blood samples. PARTICIPANTS Descriptive data were generated from the eLIXIR database from 1 October 2018 to 30 June 2019. Over 17 000 electronic patient records were included. FINDINGS TO DATE 10 207 women accessed antenatal care from the 2 NHS maternity services, with 8405 deliveries (8772 infants). This diverse, inner-city maternity service population was born in over 170 countries with an ethnic profile of 46.1% white, 19.1% black, 7.0% Asian, 4.1% mixed and 4.1% other. Of the 10 207 women, 11.6% had a clinical record in mental health services with 3.0% being treated during their pregnancy. This first data extract included 947 infants treated in the neonatal intensive care unit, of whom 19.1% were postnatal transfers from external healthcare providers. FUTURE PLANS Electronic health records provide potentially transformative information for life course research, integrating physical and mental health disorders and outcomes in routine clinical care. The eLIXIR database will grow by ~14 000 new maternity cases annually, in addition to providing child follow-up data. Additional datasets will supplement the current linkage from other local and national resources, including primary care and hospital inpatient data for mothers and their children.
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Affiliation(s)
- Lauren E Carson
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Borscha Azmi
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Amelia Jewell
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Clare L Taylor
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Angela Flynn
- Department of Women and Children's Health, King's College London, London, UK
| | - Carolyn Gill
- Department of Women and Children's Health, King's College London, London, UK
- Women's Health Academic Centre KHP, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Matthew Broadbent
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Louise Howard
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Section of Women's Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, London, UK
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