A cost-effectiveness analysis of the intrapartum fetal pulse oximetry multicentre randomised controlled trial (the FOREMOST trial)

Authors

  • CE East,

    Corresponding author
    1. Perinatal Research Centre, The University of Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
      Dr CE East, Perinatal Research Centre, The University of Queensland, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia. Email ceast@somc.uq.edu.au
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  • MB Gascoigne,

    1. Centre for Burden of Disease and Cost Effectiveness, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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  • CM Doran,

    1. Centre for Burden of Disease and Cost Effectiveness, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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  • SP Brennecke,

    1. Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women’s Hospital, Melbourne, Victoria, Australia
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  • JF King,

    1. Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women’s Hospital, Melbourne, Victoria, Australia
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  • PB Colditz

    1. Perinatal Research Centre, The University of Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Dr CE East, Perinatal Research Centre, The University of Queensland, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia. Email ceast@somc.uq.edu.au

Abstract

Objective  To report an economic analysis of the Australian intrapartum fetal pulse oximetry (FPO) multicentre randomised controlled trial (the FOREMOST trial), which examined whether adding FPO to conventional cardiotocographic (CTG) monitoring (intervention group) was cost-effective in reducing operative delivery rates for non-reassuring fetal status compared with the use of CTG alone (control group).

Design  Cost-effectiveness analysis of the FOREMOST trial.

Setting  Four Australian maternity hospitals, each with more than 4000 births/year.

Population  Women in labour at ≥36 weeks of gestation, with a non-reassuring CTG.

Methods  Costs were for treatment-related expenses, incorporating diagnosis-related grouping costs and direct costs (including fetal monitoring). Incremental cost-effectiveness ratio (ICER) and cost-effectiveness plane were calculated, and sensitivity analysis was conducted. The primary outcome was that of the clinical trial: operative delivery for non-reassuring fetal status avoided in the intervention group relative to that in the control group.

Main outcome measures  The ICER.

Results  The ICER demonstrated a saving of $A813 for each operative birth for non-reassuring fetal status averted by the addition of FPO to CTG monitoring compared with the use of CTG monitoring alone.

Conclusion  The addition of FPO to CTG monitoring represented a less costly and more effective use of resources to reduce operative delivery rates for non-reassuring fetal status than the use of conventional CTG monitoring alone.

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