Peer-Reviewed Journal Details
Mandatory Fields
Fawsitt CG, Bourke J, Murphy A, McElroy B, Lutomski JE, Murphy R, Greene RA.
Applied Health Economics and Health Policy
A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland.
In Press
Optional Fields
BACKGROUND: The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. OBJECTIVES: To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. METHODS: A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. RESULTS: To avoid midwifery-led care, women were willing to pay 821.13 (95% CI 761.66-1150.41); to avoid consultant-led care, women were willing to pay 795.06 (95% CI 695.51-921.15). The average cost of a package of consultant- and midwifery-led care was 1,762.12 (95% CI 1496.73-2027.51) and 1018.47 (95% CI 916.61-1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of 1491.22 (95% CI 989.35-1991.93), compared with 123.23 (95% CI -376.58 to 621.42) for consultant-led care. CONCLUSIONS: While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.
Grant Details