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Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial.
- Source :
-
BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2022 Mar 22; Vol. 22 (1), pp. 235. Date of Electronic Publication: 2022 Mar 22. - Publication Year :
- 2022
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Abstract
- Background: The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness.<br />Methods: A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses.<br />Results: Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year.<br />Conclusions: Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services.<br />Trial Registration: The trial was registered with www.<br />Clinicaltrials: gov , number NCT01777022 .<br /> (© 2022. The Author(s).)
- Subjects :
- Cost-Benefit Analysis
Critical Pathways
Decision Support Techniques
Female
Health Care Costs
Health Personnel education
Humans
Ireland
Northern Ireland
Patient Education as Topic
Pregnancy
Prenatal Care economics
Stillbirth
United Kingdom
Awareness
Fetal Movement
Perinatal Death prevention & control
Pregnant Women education
Pregnant Women psychology
Prenatal Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2393
- Volume :
- 22
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC pregnancy and childbirth
- Publication Type :
- Academic Journal
- Accession number :
- 35317772
- Full Text :
- https://doi.org/10.1186/s12884-022-04563-9