Thesis
An exploration of health economic approaches in pregnancy: incorporating maternal and fetal outcomes
- Alternative title:
- An exploration of health economic approaches in pregnancy
- Abstract:
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Background: Pregnancy presents unique challenges to economic evaluation and the valuation of health outcomes. These include: how to include both maternal and fetal health outcomes in the analysis; how to appropriately value future life; and how to account for maternal autonomy and reproductive freedom. The aim of this thesis was to develop a framework of relevant outcomes in pregnancy that could be used in economic evaluation.
Methods: First, a systematic review was conducted of cost-utility analyses in pregnancy, evaluating how maternal and fetal health outcomes have been measured and valued. Second, a qualitative secondary analysis of interviews with pregnant people was conducted. This sought to understand how people reflect on and make decisions during pregnancy. The themes from this analysis were then contextualised within health economic theory and practice. Finally, a preliminary framework of outcomes and considerations for pregnancy was developed.
Results: The systematic review identified 127 studies, and found that maternal and fetal health outcomes were included inconsistently. The assumptions made regarding the measurement and valuation of maternal and fetal health outcomes were often not stated. The qualitative analysis identified six overarching themes that shaped the decisions taken in pregnancy: autonomy, maternal health and wellbeing, fetal health and wellbeing, family building, social context and morality. These themes were contextualised in terms of health economic theory and methods to develop a set of concepts relevant to decision-making in pregnancy. These were refined into a framework which was applied to three published examples to identify outstanding areas of research.
Conclusions: This thesis presents a preliminary framework that reconceptualises pregnancy in health economic terms. It highlights a range of outstanding normative and methodological questions that need to be answered to enhance the consistency, transparency and fairness of resource allocation for healthcare during pregnancy.
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- Files:
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(Preview, Dissemination version, pdf, 1.9MB, Terms of use)
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Authors
Contributors
+ McManus, R
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Primary Care Health Sciences
- Oxford college:
- Green Templeton College
- Role:
- Supervisor
- ORCID:
- 0000-0003-3638-028X
+ Mcniven, A
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Primary Care Health Sciences
- Role:
- Supervisor
+ Dakin, H
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Nuffield Department of Population Health
- Oxford college:
- St Cross College
- Role:
- Supervisor
- ORCID:
- 0000-0003-3255-748X
+ Rivero-Arias, O
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Women's & Reproductive Health
- Sub department:
- NPEU
- Role:
- Supervisor
- ORCID:
- 0000-0003-2233-6544
+ Wellcome Trust
More from this funder
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 217826/Z/19/Z
- DOI:
- Type of award:
- DPhil
- Level of award:
- Doctoral
- Awarding institution:
- University of Oxford
- Language:
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English
- Keywords:
- Deposit date:
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2026-07-27
- ARK identifier:
Terms of use
- Copyright holder:
- Lucy Abel
- Copyright date:
- 2026
- Licence:
- CC Attribution (CC BY)
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