Health Economics at Bristol (HEB), Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
Appl Health Econ Health Policy. 2017 Dec;15(6):785-794. doi: 10.1007/s40258-017-0344-8.
The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration.
To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis.
A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective.
To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66-1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51-921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73-2027.51) and €1018.47 (95% CI 916.61-1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35-1991.93), compared with €123.23 (95% CI -376.58 to 621.42) for consultant-led care.
While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.
爱尔兰政府已承诺在全国范围内扩大助产士主导的护理以及顾问主导的护理，尽管对于这种配置的潜在净效益知之甚少。
使用意愿评估技术和成本效益分析，正式比较爱尔兰主要护理模式的成本和效益，以期为优先事项设定提供信息。
从事前角度采用边际支付标准意愿支付问题。邀请了 450 名孕妇参与研究。主要收集成本估算，描述了一揽子护理的平均成本。使用第三方支付者的角度计算了为期一年的周期内的净效益估算。
为了避免助产士主导的护理，女性愿意支付 821.13 欧元（95%CI761.66-1150.41）；为了避免顾问主导的护理，女性愿意支付 795.06 欧元（95%CI695.51-921.15）。顾问和助产士主导的护理一揽子计划的平均成本分别为 1762.12 欧元（95%CI1496.73-2027.51）和 1018.47 欧元（95%CI916.61-1120.33）。与顾问主导的护理相比，助产士主导的护理被认为是资源的最佳利用，产生了 1491.22 欧元（95%CI989.35-1991.93）的净效益，而顾问主导的护理的净效益为 123.23 欧元（95%CI-376.58 至 621.42）。
虽然这两种护理模式都具有成本效益，但提供这两种替代方案的决定可能受到资源问题的限制。如果只能实施一种替代方案，那么低风险的女性应该接受助产士主导的护理，而高风险的女性应该接受顾问主导的护理。然而，追求一种替代方案与政府政策的一个关键目标相矛盾，该目标旨在提高产妇的选择权。理想情况下，应追求多种替代方案。
