Impact on perinatal health and cost-effectiveness of risk-based care in obstetrics: a before-after study

• Published in: American journal of obstetrics and gynecology 2020-09, Vol.223 (3), p.431.e1-431.e18
• Main Authors: van Montfort, Pim, Scheepers, Hubertina C.J., Dirksen, Carmen D., van Dooren, Ivo M.A., van Kuijk, Sander M.J., Meertens, Linda J.E., Wijnen, Ella J., Zelis, Maartje, Zwaan, Iris M., Spaanderman, Marc E.A., Smits, Luc J.M.
• Format: Article
• Language: English
• Subjects: cost-effectiveness; implementation; perinatal outcomes; prediction; pregnancy; quality of life
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2020.02.036

Obstetric health care relies on an adequate antepartum risk selection. Most guidelines used for risk stratification, however, do not assess absolute risks. In 2017, a prediction tool was implemented in a Dutch region. This tool combines first trimester prediction models with obstetric care paths tailored to the individual risk profile, enabling risk-based care. To assess impact and cost-effectiveness of risk-based care compared to care-as-usual in a general population. A before-after study was conducted using 2 multicenter prospective cohorts. The first cohort (2013–2015) received care-as-usual; the second cohort (2017–2018) received risk-based care. Health outcomes were (1) a composite of adverse perinatal outcomes and (2) maternal quality-adjusted life-years. Costs were estimated using a health care perspective from conception to 6 weeks after the due date. Mean costs per woman, cost differences between the 2 groups, and incremental cost effectiveness ratios were calculated. Sensitivity analyses were performed to evaluate the robustness of the findings. In total 3425 women were included. In nulliparous women there was a significant reduction of perinatal adverse outcomes among the risk-based care group (adjusted odds ratio, 0.56; 95% confidence interval, 0.32–0.94), but not in multiparous women. Mean costs per pregnant woman were significantly lower for risk-based care (mean difference, –€2766; 95% confidence interval, –€3700 to –€1825). No differences in maternal quality of life, adjusted for baseline health, were observed. In the Netherlands, risk-based care in nulliparous women was associated with improved perinatal outcomes as compared to care-as-usual. Furthermore, risk-based care was cost-effective compared to care-as-usual and resulted in lower health care costs.