132Is there an optimal PP stay in hospital

No 621Study Quality: ++Home-based care after a shortened hospital stay versus hospital-based care postpartum: an economic evaluation
Author:Petrou S;Boulvain M;Simon J;Maricot P;Borst F;Perneger T;Irion O;2004
Relevance:This paper shows that there are cost savings attached to early discharge amongst low risk neonates (and no clinical disadvantages). The relevance of this hinges on whether the definitions of early discharge used are appropriate.
Intervention:Early discharge (24–48 hours after a vaginal delivery 72–96 hours after a caesarian section) followed by an average of 4.7 midwife visits in the first 10 days
Comparison:Standard release (4–5 days after a vaginal delivery 6–7 days after a caesarian section) followed by no midwifery care unless clinically indicated
Population:459 mothers at the University Hospital, Geneva were randomly assigned to the control (n=231) and the intervention (n=228). The infants were all single and had an unproblematic
PerspectiveSOCIETAL
StudyCEA
Methods:RCT
Healthvaluations:NOT APPLICABLE
Costcomponents:Post natal hospital care, hospital readmissions, hospital outpatient care, community care, direct non-medical costs, indirect costs
Currency:OTHER
CostSwiss Francs (2000)
Timehorizon:28 days
Discount rate:Not appropriate
Results cost/patient:7798 Swiss Francs in the early discharge group. 9019 Swiss Francs in the hospital group. The difference between to two is statistically significant (p=0.017). Subdividing the costs into the cost components, the only statistically significant (at 5%) components of cost are the cost of post natal hospital care (p=0.001) and the cost of community care (p<0.001)
Results effectiveness:The results showed no statistically significant difference in hospital readmissions by the mother or the infant, their utilisation of outpatient care and community care services
Results incremental:Since there was no statistically significant difference in terms of outcomes, the statistically significant reduction in costs means the early discharge scheme weakly dominates the control.
Results Uncertainty:A sensitivity analysis was undertaken, varying each model parameter to discern a change in the conclusion. The non-parametric approach showed that the mean difference in costs between the control and the intervention remained between 202 Swiss Francs per mother and 2155 Swiss Francs per mother. This remained significant at the 5% level.
Source Funding:Public
Comments:
 An analysis on the generalisability of the results to the England and Wales setting has been performed. It suggests the conclusions remain valid once different cost levels are established
 The use of a societal perspective is unproblematic in this instance as there is no statistically significant difference in indirect costs between the intervention and the control.

From: Appendix D, Health Economic Extractions by Question

Cover of Postnatal Care
Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet].
NICE Clinical Guidelines, No. 37.
National Collaborating Centre for Primary Care (UK).
Copyright © 2006, National Collaborating Centre for Primary Care.

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