COST-MINIMIZATION ANALYSIS OF DOMICILIARY ANTENATAL FETAL MONITORING IN HIGH-RISK PREGNANCIES

Objective: To compare safety and cost-effectiveness of domiciliary ant enatal fetal monitoring (cardiotocography and obstetric surveillance) with in-hospital monitoring in highrisk pregnancies. Methods: From Sep tember 1992 to June 1994, 150 consecutive women with high-risk pregnan cies, who would otherwise be monitored in the hospital, entered a rand omized controlled trial of in-hospital (n = 74) or domiciliary (n = 76 ) monitoring. The main outcome measures were neonatal safety (Prechtl neurologic optimality score, the proportion of non-optimals) and cost- effectiveness. To test a two-point difference in mean Prechtl scores ( two-tailed alpha = .05, 1-beta = .80), 150 women were needed. Safety a nd cost-effectiveness were analyzed according to intention to treat. C onditional on the safety outcomes, a cost-minimization analysis based on actual resource use was performed. Uncertainty of results was explo red by sensitivity analyses. Results: Neonatal outcomes were equal. No cost-shifting between the antenatal and postpartum period occurred. S ubstituting domiciliary for in-hospital monitoring reduced mean (stand ard deviation) antenatal costs from $3558 ($2841) to $1521 ($1459) per woman (P < .001). If costs were varied by the addition of 50%, costs were still reduced. The magnitude of the reduction was sensitive to th e costs of hospital care and less sensitive to the costs of domiciliar y monitoring. Conclusion: Domiciliary monitoring is safe and reduces c osts by one-half. The technique seems transferable to other settings b ut local circumstances may sometimes hamper its dissemination. (C) 199 7 by The American College of Obstetricians and Gynecologists.