TY - JOUR
T1 - A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study)
AU - Kenny, Christopher
AU - Devane, Declan
AU - Normand, Charles
AU - Clarke, Mike
AU - Howard, Aoife
AU - Begley, Cecily
PY - 2015/11
Y1 - 2015/11
N2 - Objective: to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. Design: ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. Setting: two maternity units in Ireland, with 'alongside' midwife-led units. Participants: all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks' gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. Interventions: women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated 'alongside' the consultant-led units, throughout pregnancy, birth and postnatal. Measurements: mean difference in clinician salaries, cost of care based on managers' data, known costs of postnatal bed days and costs of key interventions were measured. Findings: the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). Key conclusions and implications for practice: care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
AB - Objective: to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. Design: ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. Setting: two maternity units in Ireland, with 'alongside' midwife-led units. Participants: all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks' gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. Interventions: women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated 'alongside' the consultant-led units, throughout pregnancy, birth and postnatal. Measurements: mean difference in clinician salaries, cost of care based on managers' data, known costs of postnatal bed days and costs of key interventions were measured. Findings: the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). Key conclusions and implications for practice: care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
KW - Cost-
KW - Economic analysis
KW - Midwife-led care
KW - Normal birth
KW - Randomised trial
UR - http://www.scopus.com/inward/record.url?scp=84945454684&partnerID=8YFLogxK
U2 - 10.1016/j.midw.2015.06.012
DO - 10.1016/j.midw.2015.06.012
M3 - Article
C2 - 26381076
AN - SCOPUS:84945454684
SN - 0266-6138
VL - 31
SP - 1032
EP - 1038
JO - MIDWIFERY
JF - MIDWIFERY
IS - 11
ER -