Ratcliffe J, Ryan M, Tucker J
Health Economics Research Unit, Aberdeen, Scotland, UK.
J Health Serv Res Policy. 1996 Jul;1(3):135-40. doi: 10.1177/135581969600100304.
To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care.
A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs.
GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = 87.25 Pounds, shared care = 91.15 Pounds, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = 127.76 Pounds, shared care = 131.09 Pounds, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = 118.53 Pounds, shared care = 133.49 Pounds, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = 83.74 Pounds, shared care = 94.43 Pounds, P = 0.46). The total societal cost of antenatal care was 417.28 Pounds per women in the GP/midwife arm of the trial and 450.19 Pounds in the shared care arm of the trial. This difference was statistically significant (P < 0.001). The application of sensitivity analysis did not change these results.
GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care.
比较传统产科医生主导的共享护理模式或全科医生（GP）/社区助产士护理模式为孕妇及其家庭提供常规产前护理时，医疗服务机构所承担的成本。
在苏格兰9家妇产医院所属的51家全科诊所开展一项多中心随机对照试验：1667名低风险孕妇提供了医疗服务机构成本方面的信息。其中704名妇女提供了非医疗服务成本方面的信息。
发现全科医生/助产士产前护理的成本在统计学上显著低于共享护理。常规产前检查的费用（全科医生/助产士 = 87.25英镑，共享护理 = 91.15英镑，P = 0.05）、常规产前检查的人员成本（全科医生/助产士 = 127.76英镑，共享护理 = 131.09英镑，P = 0.001）以及妇女及其同伴产生的非医疗服务成本（全科医生/助产士 = 118.53英镑，共享护理 = 133.49英镑，P = 0.001）均是如此。虽然试验中全科医生/助产士组的非常规护理成本低于共享护理组，但差异无统计学意义（全科医生/助产士 = 83.74英镑，共享护理 = 94.43英镑，P = 0.46）。试验中全科医生/助产士组的产前护理社会总成本为每名妇女417.28英镑，共享护理组为450.19英镑。这种差异具有统计学意义（P < 0.001）。敏感性分析的应用并未改变这些结果。
对于苏格兰的低风险孕妇而言，只要临床结局和妇女满意度至少与共享护理模式下的妇女相同，全科医生/助产士产前护理就是一个令人满意的选择。
