Costing the impact of interventions during pregnancy in the UK: A systematic review of economic evaluations

Sophie Relph; Louisa Delaney; Alexandra Melaugh; Matias C. Vieira; Jane Sandall; Asma Khalil; Dharmintra Pasupathy; Andy Healey

doi:10.1136/bmjopen-2020-040022

Costing the impact of interventions during pregnancy in the UK: A systematic review of economic evaluations

Sophie Relph^*, Louisa Delaney, Alexandra Melaugh, Matias C. Vieira, Jane Sandall, Asma Khalil, Dharmintra Pasupathy, Andy Healey

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

5 Citations (Scopus)

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Abstract

Objective: The aim of this review was to summarise the current evidence on the costing of resource use within UK maternity care, in order to facilitate the estimation of incremental resource and cost impacts potentially attributable to maternity care interventions.

Methods: A systematic review of economic evaluations was conducted by searching Medline, the Health Management Information Consortium, the National Health Service (NHS) Economic Evaluations Database, CINAHL and National Institute for Health and Care Excellence (NICE) guidelines for economic evaluations within UK maternity care, published between January 2010 and August 2019 in the English language. Unit costs for healthcare activities provided to women within the antenatal, intrapartum and postnatal period were inflated to 2018-2019 prices. Assessment of study quality was performed using the Quality of Health Economic Analyses checklist.

Results: Of 5084 titles or full texts screened, 37 papers were included in the final review (27 primary research articles, 7 review articles and 3 economic evaluations from NICE guidelines). Of the 27 primary research articles, 21 were scored as high quality, 3 as medium quality and 3 were low quality. Variation was noted in cost estimates for healthcare activities throughout the maternity care pathway: for midwife-led outpatient appointment, the range was £27.34-£146.25 (mean £81.78), emergency caesarean section, range was £1056.44-£4982.21 (mean £3508.93) and postnatal admission, range was £103.00-£870.10 per day (mean £469.55).

Conclusions: Wide variation exists in costs applied to maternity healthcare activities, resulting in challenges in attributing cost to maternity activities. The level of variation in cost calculations is likely to reflect the uncertainty within the system and must be dealt with by conducting sensitivity analyses. Nationally agreed prices for granular unit costs are needed to standardise cost-effectiveness evaluations of new interventions within maternity care, to be used either for research purposes or decisions regarding national intervention uptake.

PROSPERO registration number CRD42019145309.

Original language	English
Article number	e040022
Journal	BMJ Open
Volume	10
Issue number	10
DOIs	https://doi.org/10.1136/bmjopen-2020-040022
Publication status	Published - 30 Oct 2020

Bibliographical note

Funding Information: The DESiGN trial has been funded by the Guy’s and St Thomas’ Charity (MAJ150704), Sands Charity(RG1011/16) and Tommy’s charity UK (core support, London centre, grant number N/A). DP was also individually funded by Tommy’s charity. JS is an NIHR Senior Investigator and with SR, and AH, are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King’s College Hospital NHS Foundation Trust. MCV was supported by a Science Without Borders Fellowship from CAPES, Brazil (BEX: 9571/13–2). AM was funded by a King’s Improvement Science fellowship, funded by Guy’s and St Thomas’ and Maudsley Charity. The views expressed are those of the authors and not necessarily those of the NIHR, Department of Health and Social Care or funding charities.

Open Access: http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Publisher Copyright: © Author(s) (or their employer(s)) 2020. Published by BMJ.

Citation: Relph S, Delaney L, Melaugh A On behalf of DESiGN Trial Team, et al. Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations. BMJ Open 2020;10:e040022.

DOI: 10.1136/bmjopen-2020-040022

Keywords

antenatal
health economics
maternal medicine
obstetrics

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Relph2020CostingTheImpactOfInterventionsDuringPregnancyInTheUKBMJOpenFinal published version, 1.09 MBLicence: CC BY-NC

Cite this

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title = "Costing the impact of interventions during pregnancy in the UK: A systematic review of economic evaluations",

abstract = "Objective: The aim of this review was to summarise the current evidence on the costing of resource use within UK maternity care, in order to facilitate the estimation of incremental resource and cost impacts potentially attributable to maternity care interventions. Methods: A systematic review of economic evaluations was conducted by searching Medline, the Health Management Information Consortium, the National Health Service (NHS) Economic Evaluations Database, CINAHL and National Institute for Health and Care Excellence (NICE) guidelines for economic evaluations within UK maternity care, published between January 2010 and August 2019 in the English language. Unit costs for healthcare activities provided to women within the antenatal, intrapartum and postnatal period were inflated to 2018-2019 prices. Assessment of study quality was performed using the Quality of Health Economic Analyses checklist. Results: Of 5084 titles or full texts screened, 37 papers were included in the final review (27 primary research articles, 7 review articles and 3 economic evaluations from NICE guidelines). Of the 27 primary research articles, 21 were scored as high quality, 3 as medium quality and 3 were low quality. Variation was noted in cost estimates for healthcare activities throughout the maternity care pathway: for midwife-led outpatient appointment, the range was £27.34-£146.25 (mean £81.78), emergency caesarean section, range was £1056.44-£4982.21 (mean £3508.93) and postnatal admission, range was £103.00-£870.10 per day (mean £469.55). Conclusions: Wide variation exists in costs applied to maternity healthcare activities, resulting in challenges in attributing cost to maternity activities. The level of variation in cost calculations is likely to reflect the uncertainty within the system and must be dealt with by conducting sensitivity analyses. Nationally agreed prices for granular unit costs are needed to standardise cost-effectiveness evaluations of new interventions within maternity care, to be used either for research purposes or decisions regarding national intervention uptake. PROSPERO registration number CRD42019145309. ",

keywords = "antenatal, health economics, maternal medicine, obstetrics",

author = "Sophie Relph and Louisa Delaney and Alexandra Melaugh and Vieira, {Matias C.} and Jane Sandall and Asma Khalil and Dharmintra Pasupathy and Andy Healey",

note = "Funding Information: The DESiGN trial has been funded by the Guy{\textquoteright}s and St Thomas{\textquoteright} Charity (MAJ150704), Sands Charity(RG1011/16) and Tommy{\textquoteright}s charity UK (core support, London centre, grant number N/A). DP was also individually funded by Tommy{\textquoteright}s charity. JS is an NIHR Senior Investigator and with SR, and AH, are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King{\textquoteright}s College Hospital NHS Foundation Trust. MCV was supported by a Science Without Borders Fellowship from CAPES, Brazil (BEX: 9571/13–2). AM was funded by a King{\textquoteright}s Improvement Science fellowship, funded by Guy{\textquoteright}s and St Thomas{\textquoteright} and Maudsley Charity. The views expressed are those of the authors and not necessarily those of the NIHR, Department of Health and Social Care or funding charities. Open Access: http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2020. Published by BMJ. Citation: Relph S, Delaney L, Melaugh A On behalf of DESiGN Trial Team, et al. Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations. BMJ Open 2020;10:e040022. DOI: 10.1136/bmjopen-2020-040022 ",

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AU - Relph, Sophie

AU - Delaney, Louisa

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AU - Khalil, Asma

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AU - Healey, Andy

N1 - Funding Information: The DESiGN trial has been funded by the Guy’s and St Thomas’ Charity (MAJ150704), Sands Charity(RG1011/16) and Tommy’s charity UK (core support, London centre, grant number N/A). DP was also individually funded by Tommy’s charity. JS is an NIHR Senior Investigator and with SR, and AH, are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King’s College Hospital NHS Foundation Trust. MCV was supported by a Science Without Borders Fellowship from CAPES, Brazil (BEX: 9571/13–2). AM was funded by a King’s Improvement Science fellowship, funded by Guy’s and St Thomas’ and Maudsley Charity. The views expressed are those of the authors and not necessarily those of the NIHR, Department of Health and Social Care or funding charities. Open Access: http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Publisher Copyright: © Author(s) (or their employer(s)) 2020. Published by BMJ. Citation: Relph S, Delaney L, Melaugh A On behalf of DESiGN Trial Team, et al. Costing the impact of interventions during pregnancy in the UK: a systematic review of economic evaluations. BMJ Open 2020;10:e040022. DOI: 10.1136/bmjopen-2020-040022

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N2 - Objective: The aim of this review was to summarise the current evidence on the costing of resource use within UK maternity care, in order to facilitate the estimation of incremental resource and cost impacts potentially attributable to maternity care interventions. Methods: A systematic review of economic evaluations was conducted by searching Medline, the Health Management Information Consortium, the National Health Service (NHS) Economic Evaluations Database, CINAHL and National Institute for Health and Care Excellence (NICE) guidelines for economic evaluations within UK maternity care, published between January 2010 and August 2019 in the English language. Unit costs for healthcare activities provided to women within the antenatal, intrapartum and postnatal period were inflated to 2018-2019 prices. Assessment of study quality was performed using the Quality of Health Economic Analyses checklist. Results: Of 5084 titles or full texts screened, 37 papers were included in the final review (27 primary research articles, 7 review articles and 3 economic evaluations from NICE guidelines). Of the 27 primary research articles, 21 were scored as high quality, 3 as medium quality and 3 were low quality. Variation was noted in cost estimates for healthcare activities throughout the maternity care pathway: for midwife-led outpatient appointment, the range was £27.34-£146.25 (mean £81.78), emergency caesarean section, range was £1056.44-£4982.21 (mean £3508.93) and postnatal admission, range was £103.00-£870.10 per day (mean £469.55). Conclusions: Wide variation exists in costs applied to maternity healthcare activities, resulting in challenges in attributing cost to maternity activities. The level of variation in cost calculations is likely to reflect the uncertainty within the system and must be dealt with by conducting sensitivity analyses. Nationally agreed prices for granular unit costs are needed to standardise cost-effectiveness evaluations of new interventions within maternity care, to be used either for research purposes or decisions regarding national intervention uptake. PROSPERO registration number CRD42019145309.

AB - Objective: The aim of this review was to summarise the current evidence on the costing of resource use within UK maternity care, in order to facilitate the estimation of incremental resource and cost impacts potentially attributable to maternity care interventions. Methods: A systematic review of economic evaluations was conducted by searching Medline, the Health Management Information Consortium, the National Health Service (NHS) Economic Evaluations Database, CINAHL and National Institute for Health and Care Excellence (NICE) guidelines for economic evaluations within UK maternity care, published between January 2010 and August 2019 in the English language. Unit costs for healthcare activities provided to women within the antenatal, intrapartum and postnatal period were inflated to 2018-2019 prices. Assessment of study quality was performed using the Quality of Health Economic Analyses checklist. Results: Of 5084 titles or full texts screened, 37 papers were included in the final review (27 primary research articles, 7 review articles and 3 economic evaluations from NICE guidelines). Of the 27 primary research articles, 21 were scored as high quality, 3 as medium quality and 3 were low quality. Variation was noted in cost estimates for healthcare activities throughout the maternity care pathway: for midwife-led outpatient appointment, the range was £27.34-£146.25 (mean £81.78), emergency caesarean section, range was £1056.44-£4982.21 (mean £3508.93) and postnatal admission, range was £103.00-£870.10 per day (mean £469.55). Conclusions: Wide variation exists in costs applied to maternity healthcare activities, resulting in challenges in attributing cost to maternity activities. The level of variation in cost calculations is likely to reflect the uncertainty within the system and must be dealt with by conducting sensitivity analyses. Nationally agreed prices for granular unit costs are needed to standardise cost-effectiveness evaluations of new interventions within maternity care, to be used either for research purposes or decisions regarding national intervention uptake. PROSPERO registration number CRD42019145309.

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Costing the impact of interventions during pregnancy in the UK: A systematic review of economic evaluations

Abstract

Bibliographical note

Keywords

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