title: Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.
abstract: OBJECTIVE
  To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only.
  
  
  METHODS
  Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG.
  
  
  METHODS
  Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring.
  
  
  METHODS
  A trial-based cost-effectiveness analysis was performed from a health-care provider perspective.
  
  
  METHODS
  Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis.
  
  
  RESULTS
  The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667.
  
  
  CONCLUSIONS
  The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery.
authors: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. sylviavijgen@hotmail.com
authors: Sylvia M C
authors: SM
authors: Vijgen
authors: Michelle E M H
authors: ME
authors: Westerhuis
authors: Brent C
authors: BC
authors: Opmeer
authors: Gerard H A
authors: GH
authors: Visser
authors: Karl G M
authors: KG
authors: Moons
authors: Martina M
authors: MM
authors: Porath
authors: Guid S
authors: GS
authors: Oei
authors: Herman P
authors: HP
authors: Van Geijn
authors: Antoinette C
authors: AC
authors: Bolte
authors: Christine
authors: C
authors: Willekes
authors: Jan G
authors: JG
authors: Nijhuis
authors: Erik
authors: E
authors: Van Beek
authors: Giuseppe C M
authors: GC
authors: Graziosi
authors: Nico W E
authors: NW
authors: Schuitemaker
authors: Jan M M
authors: JM
authors: Van Lith
authors: Eline S A
authors: ES
authors: Van Den Akker
authors: Addy P
authors: AP
authors: Drogtrop
authors: Hendrikus J H M
authors: HJ
authors: Van Dessel
authors: Robbert J P
authors: RJ
authors: Rijnders
authors: Herman P
authors: HP
authors: Oosterbaan
authors: Ben Willem J
authors: BW
authors: Mol
authors: Anneke
authors: A
authors: Kwee
mesh_terms: D000138:Acidosis / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D015148:Cardiotocography / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics / Q000379:methods; D004562:Electrocardiography / Q000191:economics* / Q000379:methods; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005323:Fetal Monitoring / Q000191:economics* / Q000379:methods; D005865:Gestational Age; D017048:Health Care Costs; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D018566:Pregnancy, High-Risk; D055815:Young Adult