IntroductionGroup antenatal care (gANC) is a group-based care-model combining routine antenatal care, with health assessment, education, and community building. GANC has shown positive results on... Show moreIntroductionGroup antenatal care (gANC) is a group-based care-model combining routine antenatal care, with health assessment, education, and community building. GANC has shown positive results on perinatal outcomes. However, midwives in Dutch primary care have reported higher costs when providing gANC. The purpose of this study was to assess the effect of replacing individual prenatal care (IC) by gANC on (expected future) health care costs and health outcomes.MethodsWe performed an exploratory cost-benefit analysis comparing costs and consequences of gANC with those of IC, using a hypothetical cohort of 12,894 women in gANC. Primary input data were derived from a stepped wedge cluster randomized controlled trial carried out in the Netherlands, assessing both health and psychosocial effects of gANC comparing them with IC. Other data was retrieved from available literature and an online questionnaire among midwifery practices. The main outcome measure was differential cost of gANC and lifetime direct healthcare costs related to the effects of gANC compared to IC (price level 2019).ResultsResults showed that gANC comes at a differential cost of €45 extra per person when compared to IC. However, projected healthcare cost-savings related to increased breastfeeding rates, reduced prevalence of pregnancy induced hypertension and less postpartum smoking, lead to an average net cost-savings of €67 per gANC participant.DiscussionAlthough gANC shows better health- and psychosocial outcomes when compared to IC, it is more costly to provide. However, findings indicate that the differential costs of gANC are off-set by long-term healthcare cost-savings. Show less
Wagijo, M.A.; Crone, M.; Zwicht, B.; Lith, J. van; Billings, D.L.; Rijnders, M. 2023
The objective of this study was to assess the effects of CenteringPregnancy (CP) in the Netherlands on different health outcomes. A stepped wedged cluster randomized trial was used, including 2132... Show moreThe objective of this study was to assess the effects of CenteringPregnancy (CP) in the Netherlands on different health outcomes. A stepped wedged cluster randomized trial was used, including 2132 women of approximately 12 weeks of gestation, from thirteen primary care midwifery centres in and around Leiden, Netherlands. Data collection was done through self-administered questionnaires. Multilevel intention-to-treat analysis and propensity score matching for the entire group and separately for nulliparous- and multiparous women were employed. The main outcomes were: health behaviour, health literacy, psychological outcomes, health care use, and satisfaction with care. Women’s participation in CP is associated with lower alcohol consumption after birth (OR = 0.59, 95 %CI 0.42–0.84), greater consistency with norms for healthy eating and physical activity (β = 0.19, 95 %CI 0.02–0.37), and higher knowledge about pregnancy (β = 0.05, 95 %CI 0.01–0.08). Compared to the control group, nulliparous women who participating in CP reported better compliance to the norm for healthy eating and physical activity (β = 0.28, 95 %CI0.06–0.51)) and multiparous CP participants consumed less alcohol after giving birth (OR = 0.42, 95 %CI 0.23–0.78). Health care use and satisfaction rates were significantly higher among CP participants. A non-significant trend toward lower smoking rates was documented among CP participants. Overall, the results of this study reveal a positive (postpartum) impact on fostering healthy behaviours among participants. Show less
