The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone.
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.


METHODS
A cost-effectiveness analysis based on a probabilistic decision model incorporating relevant strategies and lifelong outcomes.


METHODS
Maternity wards in Sweden.


METHODS
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.


METHODS
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 euro56 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.
Heintz
E
E
Center for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden. emelie.heintz@liu.se
Brodtkorb
T-H
TH
Nelson
N
N
Levin
L-A
LA
D015148:Cardiotocography / Q000191:economics*; D002547:Cerebral Palsy / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D036861:Delivery, Obstetric; D004562:Electrocardiography; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis