Table 5.
Economic evaluations of midwifery by income level
| High income countries (n = 26) | Low- and middle-income countries (n = 6) | Total (n = 32) | |
|---|---|---|---|
| Economic evaluation design | |||
| Full economic evaluation | 12 | 3 | 15 |
| Cost-benefit analysis | 1 | 1 | |
| Cost-effectiveness analysis | 7 | 2 | |
| Cost-minimisation analysis | 2 | – | |
| Cost-utility analysis | 2 | – | 2 |
| Partial economic evaluation | 14 | 3 | 17 |
| Cost-comparison analysis | 14 | 1 | 15 |
| Cost analysis | 2 | 2 | |
| Research design | |||
| Case study approach | 2 | 2 | |
| Cross-sectional study | 1 | – | 1 |
| Longitudinal cohort study | 1 | – | 1 |
| Matched control design | 1 | – | 1 |
| Micro-costing study | 2 | – | 2 |
| Prospective cohort study | 4 | – | 4 |
| Randomised control trial | 5 | – | 5 |
| Retrospective and prospective cohort study | 1 | 1 | 2 |
| Retrospective cohort study | 4 | – | 4 |
| Willingness-to-pay survey | 1 | – | 1 |
| Cost analysis design only | 2 | 1 | 3 |
| Modelling design only | 4 | 2 | 6 |
| Modelling used | |||
| No | 19 | 3 | 22 |
| Yes | 7 | 3 | 10 |
| Budget impact modelling | 1 | 1 | |
| Decision tree modelling | 3 | 1 | 4 |
| Markov microsimulation model | 1 | 1 | |
| Population-based simulation modelling | 2 | 2 | 4 |
| Perspective | |||
| Education funder | 1 | 1 | |
| Healthcare funder/provider | 24 | 1 | 25 |
| Societal | 2 | 2 | 4 |
| Not stated/unclear | 2 | 2 | |
| Study focus | |||
| Education | 3 | 3 | |
| Midwifery pre-service education | 2 | 2 | |
| Midwifery in-service education | 1 | 1 | |
| Service provision and education | 1 | 1 | |
| Service provision – midwife-led care | 14 | 1 | 15 |
| Service provision – place of birth | 12 | 1 | 13 |
| Midwife-led birth unit | 5 | 1 | 6 |
| Midwife-led birth unit and home birth | 4 | 4 | |
| Midwife-led home birth | 3 | 3 | |
| Comparator | |||
| Standard care (varied descriptions) | 14 | 2 | 16 |
| Obstetrician-led care | 8 | 1 | 9 |
| Family physician-led care | 1 | 1 | |
| Family physician-led and obstetrician-led care | 1 | 1 | |
| Standard care and obstetrician-led care | 1 | 1 | |
| Short-stay hospital birth | 1 | 1 | |
| No comparator | 3 | 3 | |
| Recipients of care | |||
| All women | 4 | 2 | 6 |
| Low-risk nulliparous women | 2 | 2 | |
| Low-risk women | 20 | 1 | 21 |
| Low-risk newborns | 1 | 1 | |
| N/A (education only) | 2 | 2 | |
| Time horizon for primary economic evaluation | |||
| < 1 year | 21 | 1 | 22 |
| ≥ 1 year | 4 | 1 | 5 |
| 2 years | 1 | 1 | |
| 6 years (education) | 1 | 1 | |
| Unclear | 3 | 3 | |
| Antenatal care costs considered | |||
| Antenatal care considered | 18 | 2 | 20 |
| 16 weeks onwards | 1 | 1 | |
| 36 weeks onwards | 1 | 1 | |
| 37 weeks onwards | 1 | 1 | |
| 39 weeks onwards | 1 | 1 | |
| Not stated | 14 | 2 | 16 |
| Not considered/costed | 8 | 1 | 9 |
| N/A (Education only) | 3 | 3 | |
| Intrapartum and birth care costs considered | |||
| Intrapartum care considered | 26 | 3 | 29 |
| Inpatient birth | 1 | 1 | |
| Inpatient labour and birth | 25 | 3 | 28 |
| Not considered/costed | |||
| N/A (Education only) | 3 | 3 | |
| Postpartum care costs considered | |||
| Postpartum care considered | 19 | 2 | 21 |
| 7 days | 2 | 2 | |
| 2 weeks | 1 | 1 | |
| 4 weeks | 3 | 3 | |
| 6 weeks | 6 | 6 | |
| 2 months | 1 | 1 | |
| 3 months | 1 | 1 | |
| 1 year | 2 | 2 | |
| 2 years | 1 | 1 | |
| Not stated | 2 | 2 | 4 |
| Newborn only | 1 | 1 | |
| 7 days | 1 | 1 | |
| Not considered/costed | 7 | 1 | 8 |
| N/A (education only) | 2 | 2 | |