title: The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone.
abstract: 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.
authors.affiliation: Center for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden. emelie.heintz@liu.se
authors.forename: E
authors.initials: E
authors.lastname: Heintz
authors.forename: T-H
authors.initials: TH
authors.lastname: Brodtkorb
authors.forename: N
authors.initials: N
authors.lastname: Nelson
authors.forename: L-A
authors.initials: LA
authors.lastname: Levin
mesh_terms: 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