The long‐term cost‐effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone

Abstract

Objective To assess the cost‐effectiveness of the use of cardiotocography (CTG) complemented with fetal electrocardiography and ST analysis compared with the use of CTG alone in term deliveries when a decision has been made to use fetal monitoring with a scalp electrode.Design A cost‐effectiveness analysis based on a probabilistic decision model incorporating relevant strategies and lifelong outcomes.Setting Maternity wards in Sweden.Population Women with term fetuses after a clinical decision had been made to apply a fetal scalp electrode for internal CTG.Methods A decision model was used to compare the costs and effects of two different treatment strategies. Baseline estimates were derived from the literature. Discounted costs and quality‐adjusted life years (QALYs) were simulated over a lifetime horizon using a probabilistic model.Main outcome measures QALYs, incremental costs, and cost per QALY gained expressed as incremental cost‐effectiveness ratio (ICER).Results The analysis found an incremental effect of 0.005 QALYs for ST analysis compared with CTG; the ST analysis strategy was also moreover associated with a €56 decrease in costs, thus dominating the CTG strategy. The probability that ST analysis is cost‐effective in comparison with CTG is high, irrespective of the willingness‐to‐pay value for a QALY.Conclusions Compared with CTG alone, ST analysis is cost‐effective when used in term high‐risk deliveries in which there is a need for internal fetal monitoring.