Modelling the cost of place of birth: a pathway analysis

Scarf, VL; Yu, S; Viney, R; Cheah, SL; Dahlen, H; Sibbritt, D; Thornton, C; Tracy, S; Homer, C

Modelling the cost of place of birth: a pathway analysis

Scarf, VL Yu, S

Viney, R

Cheah, SL Dahlen, H Sibbritt, D

Thornton, C Tracy, S Homer, C

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Publisher:: BioMed Central
Publication Type:: Journal Article
Citation:: BMC Health Services Research, 2021, 21, (1), pp. 1-11
Issue Date:: 2021-08-14

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Field	Value	Language
dc.contributor.author	Scarf, VL
dc.contributor.author	Yu, S https://orcid.org/0000-0002-1070-113X
dc.contributor.author	Viney, R https://orcid.org/0000-0002-0039-9635
dc.contributor.author	Cheah, SL
dc.contributor.author	Dahlen, H
dc.contributor.author	Sibbritt, D https://orcid.org/0000-0003-3561-9447
dc.contributor.author	Thornton, C
dc.contributor.author	Tracy, S
dc.contributor.author	Homer, C https://orcid.org/0000-0002-7454-3011
dc.date.accessioned	2021-12-21T22:13:41Z
dc.date.available	2021-07-23
dc.date.available	2021-12-21T22:13:41Z
dc.date.issued	2021-08-14
dc.identifier.citation	BMC Health Services Research, 2021, 21, (1), pp. 1-11
dc.identifier.issn	1472-6963
dc.identifier.issn	1472-6963
dc.identifier.uri	http://hdl.handle.net/10453/152451
dc.description.abstract	Background In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. Objectives The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. Methods This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. Findings 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. Conclusion The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.
dc.format	Electronic
dc.language	eng
dc.publisher	BioMed Central
dc.relation	http://purl.org/au-research/grants/nhmrc/1103015
dc.relation	http://purl.org/au-research/grants/nhmrc/APP1103015
dc.relation.ispartof	BMC Health Services Research
dc.relation.isbasedon	10.1186/s12913-021-06810-9
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0807 Library and Information Studies, 1110 Nursing, 1117 Public Health and Health Services
dc.subject.classification	Health Policy & Services
dc.subject.mesh	Humans
dc.subject.mesh	Home Childbirth
dc.subject.mesh	Pregnancy
dc.subject.mesh	Parturition
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Birthing Centers
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Birth Setting
dc.subject.mesh	Australia
dc.subject.mesh	Birth Setting
dc.subject.mesh	Birthing Centers
dc.subject.mesh	Female
dc.subject.mesh	Home Childbirth
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Parturition
dc.subject.mesh	Pregnancy
dc.title	Modelling the cost of place of birth: a pathway analysis
dc.type	Journal Article
utslib.citation.volume	21
utslib.location.activity	England
utslib.for	0807 Library and Information Studies
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2021-12-21T22:13:38Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	21
utslib.citation.issue	1

Abstract:

Background In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. Objectives The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. Methods This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. Findings 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. Conclusion The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.

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http://hdl.handle.net/10453/152451