Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, Oslo, 0130, Norway.
Oslo University Hospital, Forskningsveien 2b, Oslo, 0373, Norway.
BMC Health Serv Res. 2024 Sep 30;24(1):1150. doi: 10.1186/s12913-024-11631-7.
Evidence exists that planned home births for low-risk women in settings in which they have access to hospital transfer if needed are safe. The costs of planned home births, compared to low-risk births in obstetric units, are not clear. The aim of this study was to compare costs associated with hospital births versus home births under different home birth organizations.
We performed a cost minimisation analysis (CMA) based on decision-analytic modelling while assuming that health outcomes were not affected by place of birth. Estimations of resource use were mainly based on three existing Norwegian datasets: (1) women with planned home births (n = 354), (2) women with planned home births (n = 482) of which 63 were transferred to a hospital, and (3) women with planned births in a hospital (n = 1550).
Planned home birth costs 45.9% (credibility interval [CrI] 39.1-54.2) of a low-risk birth at a hospital. For planned home birth, the birth was the costliest activity (32.1%). The costs for planned home birth were estimated to be €1872 (CrI 1694-2071) and included hospitalisations for some. Costs for only those with actual home birth was €1353 (CrI 1244-1469). Costs of a birth, including possible birth-related complications, in low-risk women in a hospital was €4077 (CrI 3575-4615). When including the costs of being on call for one woman at a time, a planned home birth costs €5,531 (CrI 5,171-5,906), which is 135.7% (CrI 117.7-156.8) of low-risk births at a hospital. When organizing midwives in the on call teams for multiple women at a time, a planned home birth costs € 2,842 (CrI 2,647-3,053), which is 69.7% (CrI 60.3-80.9) of a low-risk birth in a hospital.
Home birth can be cost-effective if the midwives who facilitate home births are organised into larger groups, or they work for hospitals that also facilitate home births. A model in which midwives work separately or in pairs to assist with a home birth and are on call for one birth at a time may not be cost-effective.
有证据表明，在低风险女性可以在需要时转入医院的环境中计划在家中分娩是安全的。与产科病房中的低风险分娩相比，计划在家分娩的成本尚不清楚。本研究的目的是比较在不同的家庭分娩组织中与医院分娩相关的成本。
我们进行了一项基于决策分析模型的成本最小化分析（CMA），同时假设健康结果不受分娩地点的影响。资源使用的估算主要基于三个现有的挪威数据集：（1）计划在家分娩的妇女（n=354），（2）计划在家分娩的妇女（n=482），其中 63 人转至医院，（3）计划在医院分娩的妇女（n=1550）。
计划在家分娩的低风险分娩费用为医院分娩的 45.9%（可信度区间 [CrI] 39.1-54.2）。对于计划在家分娩，分娩是最昂贵的活动（32.1%）。计划在家分娩的费用估计为 1872 欧元（CrI 1694-2071），其中包括一些住院费用。仅实际在家分娩的费用为 1353 欧元（CrI 1244-1469）。低风险女性在医院分娩的费用包括可能与分娩相关的并发症在内为 4077 欧元（CrI 3575-4615）。当包括每次为一名妇女待命的费用时，计划在家分娩的费用为 5531 欧元（CrI 5171-5906），是医院低风险分娩的 135.7%（CrI 117.7-156.8）。当将助产士在多个妇女的待命团队中组织起来时，计划在家分娩的费用为 2842 欧元（CrI 2647-3053），是医院低风险分娩的 69.7%（CrI 60.3-80.9）。
如果促进家庭分娩的助产士被组织成更大的团体，或者他们在也促进家庭分娩的医院工作，家庭分娩可能具有成本效益。助产士单独或成对工作以协助家庭分娩并每次仅为一次分娩待命的模式可能没有成本效益。
