Abstract
Objective: To undertake a cost minimisation study of ST
analysis (STan) plus cardiotocograpy (CTG) compared to CTG alone.
Design: Cost-minimisation analysis alongside a randomised
controlled trial (1).
Setting: A tertiary level maternity centre in Adelaide, South
Australia.
Population: Women in labour ≥36 weeks gestation, with a
clinical indication for continuous electronic fetal monitoring.
Methods: We utlilised a health service perspective covering
randomisation to final maternal and neonatal discharge, including
readmissions. Primary analysis was intention to treat, with secondary
per protocol analysis. Post hoc analyses were conducted by
sub-groups and after exclusion of outliers.
Main outcome measure: Average cost per mother/baby dyad.
Results: Costs were calculated for 957/968 patients (98.9%)
using hospital financial data. There was no statistically significant
evidence of difference between the two study arms but lower costs
observed in the STan arm. Average cost per mother/baby dyad was
AUD12,768 for Stan+CTG, compared with AUD15,027 for CTG alone. Lower
costs were mainly due to lower neonatal costs, particularly for critical
care. Maternal labour cost was nearly identical in the two arms. The
difference was still shown, although with reduced magnitude, when
outliers were removed and increased with a per protocol analysis.
Conclusion: While not statistically significant, reduced costs
were observed in the CTG+STan arm (average reduction per mother / baby
dyad = AUD2,259).
Funding: Australian National Health and Medical Research
Council (NH&MRC) project grant (1129648)
Keywords: Cost-minimisation analysis, STAN, ST analysis, CTG,
cardiotocography