title: A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital.
abstract: OBJECTIVE
  to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC).
  
  
  METHODS
  a prospective non-randomised trial.
  
  
  METHODS
  an Australian metropolitan hospital.
  
  
  METHODS
  women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system.
  
  
  METHODS
  health-care costs to the hospital and government.
  
  
  METHODS
  generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category.
  
  
  RESULTS
  women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care.
  
  
  CONCLUSIONS
  for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable.
authors.affiliation: School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith University, University Drive, Meadowbrook 4131, Australia. j.toohill@griffith.edu.au
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Toohill
authors.forename: Erika
authors.initials: E
authors.lastname: Turkstra
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000328:Adult; D001315:Australia; D003266:Continuity of Patient Care / Q000191:economics; D036861:Delivery, Obstetric / Q000191:economics*; D005260:Female; D006123:Group Practice / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000191:economics; D008880:Midwifery / Q000191:economics*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D055815:Young Adult