Journal article : Review
How are maternal and fetal outcomes incorporated when measuring benefits of interventions in pregnancy? Findings from a systematic review of cost-utility analyses
- Abstract:
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Objective
Medical interventions used in pregnancy can affect the length and quality of life of both the pregnant person and fetus. The aim of this systematic review was to identify and describe the theoretical frameworks that underpin outcome measurement in cost-utility analyses of pregnancy interventions.
Methods
Searches were conducted in the Paediatric Economic Database Evaluation (PEDE) database (up to 2017), as well as Medline, Embase and EconLit (2017–2019). We included all cost-utility analyses of any intervention given during pregnancy, published in English. We conducted a narrative synthesis of: study design; outcome construction (life expectancy, quality adjustment, discount rate); and whether the Incremental Cost-Effectiveness Ratio (ICER) was constructed using maternal or fetal outcomes. Where both outcomes were included, methods for combining them were extracted.
Results
We identified 127 cost-utility analyses in pregnancy, of which 89 reported QALYs and 38 DALYs. Outcomes were considered solely for the fetus in 59 studies (47%), solely for the pregnant person in 13 studies (10%), and for both in 49 studies (39%). The choice to include or exclude one or both sets of outcomes was not consistent within particular clinical areas. Where outcomes for both mother and baby were included, methods for combining these outcomes varied. Twenty-nine studies summed QALYs/DALYs for maternal and fetal outcomes, with no adjustment. The remaining 20 took a variety of approaches designed to weigh maternal and fetal outcomes differently. These include (1) treating fetal outcomes as a component of maternal quality of life, rather than (or in addition to) an independent individual health outcome; (2) treating the maternal-fetal dyad as a single entity and applying a single utility value to each combination of outcomes; and (3) assigning a shorter time horizon to fetal outcomes to reduce the weight of lifetime fetal outcomes. Each approach made different assumptions about the relative value of maternal and fetal health outcomes, demonstrating a lack of consistency and the need for guidance.
Conclusion
Methods for capturing QALY/DALY outcomes in cost-utility analysis in pregnancy vary widely. This lack of consistency indicates a need for new methods to support the valuation of maternal and fetal health outcomes.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
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(Preview, Version of record, pdf, 1.6MB, Terms of use)
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- Publisher copy:
- 10.1186/s12955-024-02293-4
Authors
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- NIHR202450
- Programme:
- NIHR Policy Research Programme
- Funder identifier:
- https://ror.org/0281jqk77
- Grant:
- OBF/43985
- Programme:
- Oliver Bird Fund
- Grant:
- 217826/Z/19/Z
- Programme:
- Doctoral Studentship in Social Sciences and Bioethics
- Funder identifier:
- https://ror.org/0187kwz08
- Programme:
- NIHR Oxford and Thames Valley Applied Research Consortium
- Publisher:
- BioMed Central
- Journal:
- Health and Quality of Life Outcomes More from this journal
- Volume:
- 22
- Issue:
- 1
- Article number:
- 75
- Publication date:
- 2024-09-11
- Acceptance date:
- 2024-08-28
- DOI:
- EISSN:
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1477-7525
- Language:
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English
- Keywords:
- Subtype:
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Review
- Pubs id:
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2026955
- Local pid:
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pubs:2026955
- Source identifiers:
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2254232
- Deposit date:
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2024-09-11
Terms of use
- Copyright holder:
- Abel et al.
- Copyright date:
- 2024
- Rights statement:
- © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Licence:
- CC Attribution (CC BY)
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