A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland

Christopher G. Fawsitt (), Jane Bourke, Aileen Murphy, Brendan McElroy, Jennifer E. Lutomski, Rosemary Murphy and Richard A. Greene
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Christopher G. Fawsitt: University of Bristol
Jennifer E. Lutomski: Radboud Institute for Health Sciences, Radboud University Medical Center
Rosemary Murphy: Cork University Business School, University College Cork
Richard A. Greene: University College Cork

Applied Health Economics and Health Policy, 2017, vol. 15, issue 6, No 10, 785-794

Abstract: Abstract 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.

Date: 2017
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DOI: 10.1007/s40258-017-0344-8

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