A cost-benefit analysis of two alternative models of maternity care in Ireland
Applied Health Economics and Health Policy
Christopher G. Fawsitt 1, 2, 3, Jane Bourke 2, Aileen Murphy 2, Brendan McElroy 2, Jennifer E. Lutomski 4, Rosemary Murphy 2, Richard A. Greene 3
1 Bristol Medical School, University of Bristol, United Kingdom
2 Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
3 National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
4 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
Corresponding author: Dr. Christopher G. Fawsitt ()
Table S1Comparing WTP responses from the open-ended and payment scale WTP questions95% CI
WTP Type / Mean / Median / S.D. / Std. Error / 0.025 / 0.975
Open-ended WTP question
CLU / €956.03 / €1,000.00 / €739.26 / €97.07 / €706.23 / €936.02
MLU / €808.33 / €650.00 / €556.81 / €56.83 / €683.59 / €906.54
Payment scale WTP question
CLU / €821.13 / €800.00 / €485.41 / €57.61 / €761.66 / €1,150.41
MLU / €795.06 / €700.00 / €504.15 / €56.02 / €695.51 / €921.15
CLU, consultant-led unit; MLU, midwifery-led unit; WTP, willingness to pay; S.D., standard deviation; Std. error, standard error; CI, confidence interval
Table S2 Inventory of resource use in MLU and CLU
MLU / CLU
Resource use description / Resource used/duration / Mean / S.D. / Mean / S.D.
Antenatal visit to MLU a / 1 midwife for 15 mins per visit (visits) / 6.62 / 1.54 / - / -
Antenatal visit to CLU a / 1 midwife and 1 registrar for 15 mins (visits) / 0.40 / 0.50 / 6.12 / 2.20
Consultant role in overseeing antenatal visit a / Average commitment of consultant is 4.67 minutes based on 1 consultant overseeing an antenatal clinic lasting 3 hours with average of 40 women (visits) / 0.40 / 0.50 / 6.12 / 2.20
Labour length a / 3 hrs and 32 mins x 1 midwife, 37 mins x 2 midwives (MLU); 2 hrs 26 mins x 1 midwife, 32 mins x 2 midwives (CLU) (hours: mins) / 4.09 / 3.14 / 2.58 / 2.28
Postnatal length of stay / Average duration of postnatal stay (days) / 1.07b / 0.85 b / 2.10c / 2.00d
Midwife home visits after birth in MLU a / Average of 2.04 postnatal visits to mothers, spending 30 mins (visits) / 2.04 / 1.00 / - / -
Average saving in visits by public health nurse as a result of midwife's visitsa / Saving on average of 1 public health nurse visit to mothers, spending 30 mins
No. of ultrasound scans a / 1 sonographer or midwife for 20 mins / 1.29 / 0.53 / 2.12 / 1.48
No. of antepartum cardiotocographs a / 1 midwife performs CTG for 20 mins / 0.24 / 0.53 / 1.12 / 0.75
No. of biophysical profiles a / 1 midwife performs profile for 20 mins; not performed in MLU / - / - / 0.04 / 0.23
a MidU [8]
b Schroeder et al[26]
c Hospital In-patient enquiry scheme
d Since HIPE only provides information on the average postnatal length of stay, a standard deviation of two days is assumed here
MLU, midwifery-led unit; CLU, consultant-led unit; S.D., standard deviation
Table S3 Salary costs and non-pay costs
Costs and unit estimation / € / Notes / Source of cost
Midwife / 36,137.00 / Midpoint salary (grade 7) / Consolidated salary scales November 2013 [27]
PRSI / 3,884.73 / Assuming PRSI is paid at class A (10.75%) / Department of Social Protection [38]
Superannuation / 1,445.48 / Applying 4% superannuation / RIA [39]; HIQA [28]
Overheads / 9,034.25 / Overheads calculated on direct cost basis (25%) / RIA [39]; HIQA [28]
Total / 50,501.46
Unit cost per hour / 32.44 / Total staff costs/(249-25)*6.95 / RIA [39]
Public health nurse / 49,544.00 / Midpoint salary (grade 5) / Consolidated salary scales November 2013 [27]
PRSI / 5,325.98 / Assuming PRSI is paid at class A (10.75%) / Department of Social Protection [38]
Superannuation / 1,981.76 / Applying 4% superannuation / RIA [39]; HIQA [28]
Overheads / 12,386.00 / Overheads calculated on direct cost basis (25%) / RIA [39]; HIQA [28]
Total / 69,237.74
Unit cost per hour / 44.47 / Total staff costs/(249-25)*6.95 / RIA [39]
Registrar / 55,503.00 / Midpoint salary (grade 3/4) / Consolidated salary scales November 2013 [27]
PRSI / 1,115.61 / Assuming PRSI is paid at class B (registered doctors employed in civil service) (2.01) / Department of Social Protection [38]
Superannuation / 2,220.12 / Applying 4% superannuation / RIA [39]; HIQA [28]
Overheads / 13,875.75 / Overheads calculated on direct cost basis (25%) / RIA [39]; HIQA [28]
Total / 72,714.48
Unit cost per hour / 46.19 / Total staff costs/(249-22.5)*6.95 / RIA [39]
Consultant / 163,660.00 / Category II, contract Type B / Consolidated salary scales November 2013 [27]
PRSI / 3,289.57 / Assuming PRSI is paid at class B (registered doctors employed in civil service). PRSI may be absent if PRSI class S (2.01%) / Department of Social Protection [38]
Superannuation / 6,546.40 / Applying 4% superannuation / RIA [39]; HIQA [28]
Overheads / 40,915.00 / Overheads calculated on direct cost basis (25%) / RIA [39]; HIQA [28]
Total / 214,410.97
Unit cost per hour / 141.52 / Total staff costs/(249-31)*6.95 / RIA [39]
Table S4 Resulting parameter estimates from the PSA (full sample)
Range
Parameter / Point-estimate / Min / Max
Costs for MLU
Antenatal visit to MLU / €53.68 / €50.44 / €56.94
Antenatal visit to CLU / €7.88 / €5.39 / €10.44
Consultant role in overseeing A/N visit / €4.40 / €2.97 / €5.79
Labour length / €154.58 / €126.73 / €181.09
Postnatal length of stay / €735.36 / €586.61 / €887.25
Public health nurse home visits after birth in MLU / €90.76 / €79.24 / €102.35
No. of ultrasound scans / €13.96 / €12.50 / €15.47
No. of antepartum cardiotocographs / €2.60 / €1.11 / €4.11
Costs for CLU
Antenatal visit to CLU / €120.28 / €105.29 / €134.97
Consultant role in overseeing A/N visit / €67.45 / €59.04 / €75.64
Labour length / €96.16 / €76.49 / €116.22
Postnatal length of stay / €1,441.22 / €976.28 / €1,905.05
No. of ultrasound scans / €22.90 / €17.56 / €28.46
No. of antepartum cardiotocographs / €12.13 / €9.36 / €14.92
Cost estimates
Mean cost of care in a CLU / €1,760.58 / €1,296.30 / €2,225.09
Mean cost of care in a MLU / €1,063.23 / €909.60 / €1,217.58
Benefit estimates
CLU / €820.58 / €709.42 / €932.07
MLU / €793.87 / €685.28 / €904.16
Net benefit results
CLU / €123.23 / €-376.58 / €621.42
MLU / €1,491.22 / €989.35 / €1,991.93
PSA, probabilistic sensitivity analysis; MLU, midwifery-led unit; CLU, consultant-led unit; A/N, antenatal; Min, minimum value; Max, maximum value; CVM, contingent valuation method
Table S5 Resulting parameter estimates from the PSA (first-time mothers only)
Range
Parameter / Point-estimate / Min / Max
Costs for MLU
Antenatal visit to MLU / €53.68 / €50.49 / €56.92
Antenatal visit to CLU / €7.87 / €5.36 / €10.37
Consultant role in overseeing A/N visit / €4.41 / €3.01 / €5.80
Labour length / €154.89 / €127.59 / €181.85
Postnatal length of stay / €735.16 / €584.69 / €887.25
Public health nurse home visits after birth in MLU / €90.76 / €79.27 / €102.47
No. of ultrasound scans / €13.95 / €12.47 / €15.45
No. of antepartum cardiotocographs / €2.61 / €1.15 / €4.09
Costs for CLU
Antenatal visit to CLU / €120.42 / €105.60 / €135.40
Consultant role in overseeing A/N visit / €67.48 / €59.28 / €75.74
Labour length / €96.17 / €76.53 / €115.70
Postnatal length of stay / €1,441.61 / €984.11 / €1,903.27
No. of ultrasound scans / €22.92 / €17.43 / €28.32
No. of antepartum cardiotocographs / €12.10 / €9.37 / €14.87
Cost estimates
Mean cost of care in a CLU / €1,761.12 / €1,306.94 / €2,219.41
Mean cost of care in a MLU / €1,063.32 / €908.71 / €1,218.95
Benefit estimates
CLU / €887.94 / €737.00 / €1,036.44
MLU / €833.01 / €652.05 / €1,011.44
Net benefit results
CLU / €190.14 / €-322.37 / €700.53
MLU / €1,530.81 / €1,003.88 / €2,055.09
PSA, probabilistic sensitivity analysis; MLU, midwifery-led unit; CLU, consultant-led unit; A/N, antenatal; Min, minimum value; Max, maximum value; CVM, contingent valuation method