Day care versus inpatient management of nausea and vomiting of pregnancy: cost utility analysis of a randomised controlled trial. (February 2016)

• Record Type: Journal Article
• Authors: Murphy, Aileen; McCarthy, Fergus P.; McElroy, Brendan; Khashan, Ali S.; Spillane, Niamh; Marchocki, Zibi; Sarkar, Rupak K.; Higgins, John R.
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 197(2016:Feb.)
• Page Start: 78
• Page End: 82
• Publication Date: 2016-02
• Subjects: Hyperemesis gravidarum -- Day care management -- Cost utility analysis -- Economic evaluation -- Markov model; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2015.10.022
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To assess the comparative cost effectiveness of day care over inpatient management of nausea and vomiting of pregnancy (NVP). Study design: A cost utility analysis was performed using a decision analytical model in which a Markov model was constructed. The Markov model was primarily populated with data from a recently published randomised controlled trial. Which included pregnant women presenting to Cork University Maternity Hospital, a tertiary referral maternity hospital, seeking treatment for NVP. Costs and outcomes were estimated from the perspective of the Irish health service (HSE) and patients. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was also performed. A Bayesian Value of Information analysis was used to estimate the value of collecting additional information. Results: When both the healthcare provider and patient's perspective was considered, day care management of NVP remained less costly (mean €985; 95% C.I. 705–1456 vs. €3837 (2124–8466)) and more effective (9.42; 4.19–12.25 vs. 9.49; 4.32–12.39 quality adjusted life years) compared with inpatient management. The Cost Effectiveness Acceptability Curve indicates the probability that day care management is 70% more cost effective compared to inpatient management at a ceiling ratio of €45, 000 per QALY, indicating little decision uncertainty. The Bayesian Value of Information analysis indicates there is value in collecting further information; the Expected Value of Perfect Information (EVPI) is estimated to be €5.4 million. Conclusion: Day care management of NVP is cost effective compared to inpatient management.