Costs of Hysteroscopic Sterilization Versus Laparoscopic Bilateral Tubal Ligation Sterilization among Commercially-Insured Women in the United States

Abstract

Antenatal Care (FAC) model uses risk stratification and fewer clinic visits. FAC can reduce the cost of antenatal care without compromising the quality. This current analysis estimates the cost impact to the Bahamian healthcare system by introducing FAC for qualifying pregnant women. Methods: A budget impact model was based on a cost-minimization associated with introduction of FAC for qualifying pregnant women using a WHO risk stratification tool. Direct medical expenses for laboratory tests, diagnostic procedures and visit costs were included in Bahamian dollar and weighted by utilization rates obtained from the hospital data. Indirect cost estimate was based on the literature and only included loss of wages and transportation. All costs were adjusted to 2015 US dollar. Analysis was conducted from a societal perspective with three-year time horizon. One-way sensitivity analysis was performed. Results: Estimates on women qualifying for FAC were derived from a retrospective study conducted at the Princess Margaret Hospital (PMH). On average 65.5% pregnant women qualifies for FAC in the Bahamas requiring three less clinic visits compared to current Standard Antenatal Care (SAC) with no significant difference in neonatal outcomes. Estimated total base case costs for FAC vs. SAC were $800 vs. $1,280, respectively. If clinicians choose FAC for qualified pregnant women over SAC, cost savings of $480 per case, of which 70.6% was attributed to indirect cost can be realized. This can be further extrapolated to $2,829,936 in three years considering average number of FAC qualifying women delivering in PMH per year. Sensitivity analysis indicated that introduction of FAC still offers cost savings. ConClusions: Introduction of FAC using lesser number of quality visits could be a better option that offers significant cost savings towards antenatal care in the Bahamas.