title: Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review.
abstract: BACKGROUND
  There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications.
  
  
  METHODS
  Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data.
  
  
  RESULTS
  Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care.
  
  
  CONCLUSIONS
  There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
authors.affiliation: Centre for Midwifery, Child and Family Heath, University of Technology Sydney, New South Wales, Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Scarf
authors.affiliation: Centre for Midwifery, Child and Family Heath, University of Technology Sydney, New South Wales, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Catling
authors.affiliation: Centre for Health Economic Research and Evaluation, University of Technology Sydney, New South Wales, Australia.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Viney
authors.affiliation: Centre for Midwifery, Child and Family Heath, University of Technology Sydney, New South Wales, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Homer
mesh_terms: D016550:Birthing Centers / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006700:Home Childbirth / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications; D036801:Parturition; D011247:Pregnancy