The costs of alternative types of routine antenatal care for low-risk women: shared care vs care by general practitioners and community midwives.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ratcliffe
J
J
Health Economics Research Unit, Aberdeen, Scotland, UK.
Ryan
M
M
Tucker
J
J
D017046:Cost Savings / Q000191:economics; D005069:Evaluation Studies as Topic; D005194:Family Practice / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008880:Midwifery / Q000191:economics*; D009774:Obstetrics / Q000191:economics*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics* / Q000458:organization & administration; D012307:Risk Factors; D012606:Scotland; D006113:United Kingdom