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The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone
Article first published online: 13 NOV 2008
© 2008 The Authors Journal compilation © RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 115, Issue 13, pages 1676–1687, December 2008
How to Cite
Heintz, E., Brodtkorb, T.-H., Nelson, N. and Levin, L.-Å. (2008), The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone. BJOG: An International Journal of Obstetrics & Gynaecology, 115: 1676–1687. doi: 10.1111/j.1471-0528.2008.01935.x
- Issue published online: 13 NOV 2008
- Article first published online: 13 NOV 2008
- Accepted 13 August 2008.
- cerebral palsy;
- fetal monitoring;
- ST analysis
Objective To assess the cost-effectiveness of the use of cardiotocography (CTG) complemented with fetal electrocardiography and ST analysis compared with the use of CTG alone in term deliveries when a decision has been made to use fetal monitoring with a scalp electrode.
Design A cost-effectiveness analysis based on a probabilistic decision model incorporating relevant strategies and lifelong outcomes.
Setting Maternity wards in Sweden.
Population Women with term fetuses after a clinical decision had been made to apply a fetal scalp electrode for internal CTG.
Methods A decision model was used to compare the costs and effects of two different treatment strategies. Baseline estimates were derived from the literature. Discounted costs and quality-adjusted life years (QALYs) were simulated over a lifetime horizon using a probabilistic model.
Main outcome measures QALYs, incremental costs, and cost per QALY gained expressed as incremental cost-effectiveness ratio (ICER).
Results The analysis found an incremental effect of 0.005 QALYs for ST analysis compared with CTG; the ST analysis strategy was also moreover associated with a €56 decrease in costs, thus dominating the CTG strategy. The probability that ST analysis is cost-effective in comparison with CTG is high, irrespective of the willingness-to-pay value for a QALY.
Conclusions Compared with CTG alone, ST analysis is cost-effective when used in term high-risk deliveries in which there is a need for internal fetal monitoring.