Care pathways for reduced fetal movements: A cost-consequence analysis.

Objective: This study aimed to evaluate the costs and consequences of a new midwife-navigator-facilitated care pathway for reduced fetal movements.

Materials and methods: This study was conducted at a tertiary obstetric centre in Queensland, Australia and modelling occurred for this and smaller services. Two months of data from pre (n = 112 in 2019) and post (n = 141 in 2020) implementation of the care pathway were analysed with T-tests and logistic regression models to evaluate maternal and neonatal outcomes. A Markov model was built to estimate the costs and consequences of the intervention. Sensitivity analysis was conducted to test various scenarios including modelling for smaller centres.

Results: There were no statistically significant differences in clinical outcome between the intervention and usual care groups. Intervention patients spent one hour and eight minutes less time in hospital (P < 0.001). This resulted in a saving to the centre of AU$135 per patient (AU$159 083 annually). One-way sensitivity analysis suggested that cost savings would be found in all scenarios except for smaller units providing services for less than 1900 births per annum.

Conclusion(s): To our knowledge, no other care pathway involving acute obstetric care has been economically evaluated to date. Our model based on real-world presentations for reduced fetal movements confirms that midwife-navigators may be an economically beneficial implementation strategy for dealing with common obstetric conditions.