Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review

Abstract

BackgroundThere is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications.MethodsSearches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data.ResultsEleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care.ConclusionsThere are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.

Cost-effectiveness of continuity of midwifery care for women with complex pregnancy: a structured review of the literature

“…Place of birth is strongly associated with cost [22, 23, 67]. Cost is increased in hospital settings and compounded in facilities with fragmented models of care [68]. However, women with a complex pregnancy currently access many fragmented maternity models and a significant amount of their care in hospitals [11, 31].…”

Asking different questions: A call to action for research to improve the quality of care for every woman, every child

“…In all settings, there is a need to understand prevention, how to strengthen women's own capabilities, and how to enhance positive well‐being for mother and newborn in the short and longer term. Given the evidence of cost‐effectiveness and high levels of acceptability of midwife‐led continuity of care from high resource settings, and WHO recommendations for implementation of this approach where the health system is able to support it, there is a critical need to understand the mechanisms that underpin the effectiveness of these models . This should include the short and longer term outcomes subsequent to introducing these in low resource settings, and what underpins effective implementation and sustainability in all settings, using the QMNC framework. Place of birth is also of increasing interest to policy makers, and there is evidence that community (home and birth center) settings are beneficial to some women and newborns in high income settings . There is also a need to study optimal models of care in countries/settings where women are unable to access facility‐based birth for logistical reasons such as distance or economic constraints.…”

Asking different questions: A call to action for research to improve the quality of care for every woman, every child

“…Below we discuss the relevance and key components of each priority and propose some next steps for initiating a research-driven approach to decreasing preventable global maternal and newborn death and suffering. e. Place of birth is also of increasing interest to policy makers, and there is evidence that community (home and birth center) settings are beneficial for some women and newborns in high income settings (34)(35)(36)(37)(38)(39). There is also a need to study alternative models of care in settings where facility-based birth is problematic for those who cannot attend for logistical reasons such as distance or economic constraints.…”