ABSTRACT
Background: Preterm birth has lifelong implications, placing a burden on individuals, families, communities and the health system. While several interventions to reduce preterm birth have been economically evaluated, no scoping review has been undertaken. Objective: To conduct a scoping review of economic evaluations of interventions that have reduced preterm birth, identify gaps in the literature and inform future health care providers and researchers on the economic value of preterm birth reduction interventions. Methods: Databases such as PubMed, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Medline (OVID), EMBASE, NHS Health Technology Assessment, the Cost-Effectiveness Analysis Registry, and the NHS Economic Evaluation Database and grey literature were comprehensively searched for economic evaluations of interventions that reduced preterm birth conducted since 2000. Items included: preterm birth reduction, intervention, method of economic evaluation, time-horizon of analysis, study population, perspective of evaluation, effectiveness, and costs. Review processes were undertaken by two reviewers, and disagreements were resolved by the larger team. Results: Fifteen publications met the inclusion criteria, including pharmacological interventions (5), telemedicine (1), diagnostic procedures (2), public and community health (2), prenatal care and nutrition (2), father's involvement (1), doula care (1) and a comprehensive maternity service redesign (1). Variations were observed in study design, time-horizon, study population and method of evaluation. Most studies (n = 13) adopted either a healthcare payer, provider, or system perspective. Shorter timehorizons for analysis were adopted in all studies, except one that conducted a lifetime economic evaluation. All included interventions, except one, were found to be costeffective, cost-beneficial or led to cost-savings. Conclusion: Despite preterm birth placing a high economic burden on health systems and society, we found a dearth of long-term economic evaluations of prevention and reduction initiatives. Future research on preterm birth reduction initiatives should include economic evaluations.
ABSTRACT
Background: Preterm birth is the leading cause of morbidity and mortality for children under five years with First Nations babies experiencing twice the rate of other Australians. The Birthing in Our Community (BiOC) service was implemented in a metropolitan centre in Australia and showed a significant reduction in preterm birth. We aimed to assess the cost-effectiveness of the BiOC service in reducing preterm births compared to Standard Care, from a health system perspective. Methods: Women who were carrying a First Nations baby and attending the Mater Mothers Public Hospital (Brisbane, QLD, Australia) were allocated to either BiOC or Standard Care service. Birth records were extracted from the hospital's routinely collected and prospectively entered database. The time horizon extended from first presentation in pregnancy up to six weeks after birth for mothers and 28 days for infants, or until discharged from hospital. All direct antenatal, birth, postnatal and neonatal costs were included. The proportion of preterm birth was calculated, and cost was estimated in 2019 Australian dollars. The incremental cost and proportion of preterm birth differences were adjusted using inverse probability of treatment weighting methods. Findings: Between Jan 1 2013, and Jun 30, 2019, 1816 mothers gave births to 1867 First Nations babies at the Mater Mothers Public Hospital. After exclusions, 1636 mother-baby pairs were included in the analyses: 840 in the Standard Care group and 796 in the BiOC service. Relative to Standard Care, the BiOC service was associated with a reduced proportion of preterm birth (-5.34%, [95% CI -8.69%, -1.98%]) and cost savings (-AU$4810, [95% CI -7519, -2101]) per mother-baby pair. The BiOC service was associated with better outcomes and cost less than Standard Care. Interpretation: The BiOC service offers a cost-effective alternative to Standard Care in reducing preterm birth for Australian First Nations families. The cost savings were driven by less interventions and procedures in birth and fewer neonatal admissions. Investing in comprehensive, community-led models of care improves outcomes at reduced cost. Funding: The Australian National Health and Medical Research Council (APP1077036).