Table 4 Primary Articles Revieweda Study design
| Aim of Study | Sample / Setting | Design / Method | Model used (link costs & health outcomes) |
|---|---|---|---|
|
1. Gao, Y. et al. (2014). Compared CE two models, Midwifery Group Practice (MGP) against baseline cohort of Aboriginal mothers / infants. Clinical and cost analysis Australia √ |
Regional hospital, Northern Territory MGP cohort: 7 communities MGP Women = 310 MGP Babies n = 315 (Sept 2009 – June 2011) Baseline cohort: 2 communities Baseline Women n = 412 Baseline babies n = 416 (Jan 2004- Dec 2006) All risk | Economic evaluation - retrospective records audit (Baseline Jan 2004-Dec2006) prospective data collection (MGP Sept 2009-June 2011) |
Cost-consequences analysis: Australian dollars Measured/calculated direct costs per group Established comparative cost and changes post establishment MGP service from first antenatal appointment to 6 weeks postpartum for Aboriginal mothers and babies |
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2. Tracy, S.K. et al. (2013). Assess efficacy, safety and cost of caseload midwifery versus standard hospital maternity care for women of mixed obstetric risk Dec 2008 -May 2011 Australia √ |
Women of all pregnancy risk status (not stratified) Sample 1748 women 2 tertiary teaching hospital sites, 2 states, NSW / Queensland |
2 arm RCT Caseload care, Women with a named midwife n = 871 versus Women Standard Hospital Care n = 877 Intention to treat analyses |
Cost- consequences analysis: Australian dollars Cost of care per woman based on DRG separation and direct and indirect costs for resource use collected from hospital financial system Primary & secondary clinical & cost outcomes Univariate logistic regression, OR 95% CIs and Pearson χ2 test; p values; non-parametric bootstrap percentile CIs infer significance of effects |
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3. Jan S. et al. (2004). Holistic economic evaluation of an Aboriginal Community Controlled Midwifery Program in Western Sydney 1990-1996 Australia √ |
Sample: 2 groups of Aboriginal women, Western Sydney birthing between Oct 1990 – Dec 1996, Nepean & Blacktown hospitals n = 834 Antenatal care at Daruk Aboriginal Community Controlled Program, or either hospital |
Cost analyses estimated Direct Program costs and downstream savings. Retrospective case record audit |
Cost analysis: Australian dollars Clinical and cost data linked from case record and NSW Midwives Data Collection 1991–1996 with hospital data linked with Australian National DRG cost weights; Medication: PBS (pharmaceutical benefits) Diagnostic tests: MBS (medicare benefits) Sensitivity analysis used to model uncertainty |
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4. Homer C.S. et al. (2001). Assess clinical and cost difference – team community midwifery care -CMWC compared to control/ standard hospital care - SHC 1997-1998 Australia √ |
Sample of women of mixed pregnancy risk n = 1089 CMW = 550 SHC = 539 One Australian public hospital State of NSW |
RCT-Zelen Design Cost analysis: CMW vs SHC 2 teams each with 6 fulltime midwives provided care for 600 women/yr (25 births/mth/team) Calculated mean cost/woman for 9 components of maternity care |
Cost analysis: Australian dollars Mean cost/woman/group - standard errors and 95% CI calculated using bootstrap technique Components of care and cost for resources used for each woman: antenatal clinic; antenatal admission; day assessment unit; labour and birth; hospital-based postnatal care; domiciliary postnatal care; and, admission of neonates to the special care nursery (SCN), on-call costs. Salaries and wages calculated at market prices Sensitivity analysis in 3 areas: Neonatal admission to SCN; Efficiency of AN clinics; Proportion of elective CS |
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5. Rowley, M.J. et al. (1995). Examined cost/clinical differences for birth between 2 groups - Team Midwifery - 6 midwives vs routine hospital care Australia √ |
Sample of women of mixed pregnancy risk n = 814 Discrete stratification of high risk = 275 women Team midwifery n= 405 Hospital care n = 409 One Australian public hospital State of NSW |
RCT: 2 groups continuity team (midwives) vs routine care (hospital) Cost measured: Australian National Cost Weights for Diagnostic Related Groups (DRG) per birth / delivery Intention to treat |
Cost-effectiveness: Australian dollars; direct costs Multiple outcomes measured. No single measure of effectiveness derived. Australian national cost weights for diagnosis-related groups (DRGs) applied to outcomes of women for whom complete results were avail. Performed retrospectively by clerk blinded to study - based on medical records, covered inpatient costs. Cost of intervention & comparative care estimated by analysing midwives' salaries. No discounting as time-period < one year. Costs and quantities not reported separately. No sensitivity analysis undertaken. No price dates given. |
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6. Kenny, P. et al. (1994). Cost analyses: Team Midwifery Vs Standard hospital care. Included clinical outcomes Sept 1992 – July 1993 Australia √ |
Sample n = 446 women Team Midwifery n =213 Standard Care n = 233 Westmead public hospital State of NSW |
RCT 2 Arm Study Resource cost estimates: AN, birth, PN care Cost estimated where statistically significant difference in service use shown Included: direct costs, infrastructure, staff salaries - calculated for ‘low’ and ‘high’ risk women each group |
Cost analysis (Drummond1987) Costs estimated based on resource use at AN, birth and PN (including domiciliary) stages of care separately Costs based on care delivered No sensitivity analysis undertaken. Costing assumptions: cost effective if resource costs of midwifery care shown to be less or equivalent to conventional care and health benefits of midwife care relative to conventional care are shown to be positive |