Home‐based care after a shortened hospital stay versus hospital‐based care postpartum: an economic evaluation

Abstract

Objectives To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting The University Hospital of Geneva and its catchment area. Population Four hundred and fifty‐nine deliveries of a single infant at term following an uncomplicated pregnancy. Methods Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Main outcome measures Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Results Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non‐medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother–infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. Conclusions A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

Does lack of routine postnatal examination on maternity unit increase the risk of hospital admission in the first week of life?

“…Thus, from clinical experience, recognition of neonatal sepsis can potentially take longer on the community than on maternity unit. There are clearly economic benefits of the early postnatal discharge [9,13].…”

Efectos del alta hospitalaria temprana en el periodo posparto en la Clínica del Prado, Medellín, Colombia

“…Arturo CArdonA-ospinA • JAime ordoñez-molinA • elsA mAríA Vásquez-trespAlACios • lAureAno mestrA-pAlomino • rAúl AleJAndro GArCíA-posAdA tradicional, y encontraron que los resultados clínicos y psicosociales fueron similares en los dos brazos de observación, en concordancia con lo encontrando en este estudio, y el alta temprana produjo una disminución significativa de los costos hospitalarios posnatales (18). De modo similar, Sainz-Bueno et ál.…”

Le choix des bons critères de jugement : une étape cruciale en épidémiologie périnatale

“…La cure d'atosiban coûte plus de 1 000 euros, la cure de nifédipine quelques centaines d'euros, pour une efficacité similaire. Un autre exemple est celui de la sortie précoce en post-partum en comparaison du séjour à l'hôpital de trois jours ou plus qui montre sans discussion possible que la sortie précoce ne comporte pas de risque accru, est bien acceptée et permet d'économiser 1 200 francs suisses (980 euros) par accouchement [17].…”