Acta Obstet Gynecol Scand. 2011 Mar 29. doi: 10.1111/j.1600-0412.2011.01138.x. [Epub ahead of print]
Cost-effectiveness of cardiotocography plus ST-analysis of the fetal electrocardiogram compared to cardiotocography only.
Vijgen SM, Westerhuis ME, Opmeer BC, Visser GH, Moons KG, Porath MM, Oei GS, Geijn HP, Bolte AC, Willekes C, Nijhuis JG, Beek EV, Graziosi GC, Schuitemaker NW, Lith JM, Akker ES, Drogtrop AP, Dessel HJ, Rijnders RJ, Oosterbaan HP, Mol BW, Kwee A.
Academic Medical Center, Amsterdam, University Medical Center Utrecht, Utrecht, Máxima Medical Center, Veldhoven, VU Medical Center, Amsterdam, Maastricht University Medical Center, Maastricht, St Antonius Hospital, Nieuwegein, Diakonessenhuis, Utrecht, Leiden University Medical Center, Leiden, Onze Lieve Vrouwe Gasthuis, Amsterdam, Twee Steden Hospital, Tilburg, and Jeroen Bosch Hospital, Den Bosch, The Netherlands.
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 to CTG only. Design. Costeffectiveness analysis based on a randomized clinical trial on ST- analysis of the fetal ECG. Setting. 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 above 36weeks and an indication for internal electronic fetal monitoring. Methods. A trial-based cost-effectiveness analysis was performed from a health-care provider perspective. Main outcome measures. 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 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% CI 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST-analysis (n = 2827) was €1 345 versus €1 316 for CTG only (n = 2840), with a mean difference of € 29 (95% CI:-€ 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 to monitoring by CTG only and very low compared to the total costs of delivery.
© 2011 The Authors AOGS© 2011 Nordic Federation of Societies of Obstetrics and Gynecology
