Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial



Camacho, Elizabeth M, Whyte, Sonia ORCID: 0000-0003-0878-4244, Stock, Sarah J, Weir, Christopher J, Norman, Jane E and Heazell, Alexander EP
(2022) Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial. BMC PREGNANCY AND CHILDBIRTH, 22 (1). 235-.

[img] Text
Camacho et al 2022 - AFFIRM economic evaluation.pdf - Published version

Download (896kB) | Preview

Abstract

<h4>Background</h4>The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness.<h4>Methods</h4>A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses.<h4>Results</h4>Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year.<h4>Conclusions</h4>Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services.<h4>Trial registration</h4>The trial was registered with www.<h4>Clinicaltrials</h4>gov , number NCT01777022 .

Item Type: Article
Uncontrolled Keywords: Stillbirth, Perinatal death, Fetal movements, Cost-effectiveness, Randomised trial
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Clinical Directorate
Depositing User: Symplectic Admin
Date Deposited: 04 Apr 2022 14:10
Last Modified: 18 Jan 2023 21:05
DOI: 10.1186/s12884-022-04563-9
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3152071