ST analysis plus CTG compared to CTG alone for intrapartum fetal
monitoring (the START randomised controlled trial): A cost minimisation
study.
Abstract
Objective: To undertake a cost minimisation study of ST
analysis (STan) plus cardiotocograpy (CTG) compared to CTG alone.
Design: Cost-minimisation analysis alongside a randomised
controlled trial [(1)](#ref-0001). Setting: A tertiary
level maternity centre in Adelaide, South Australia.
Population: Women in labour ≥36 weeks gestation, with a
clinical indication for continuous electronic fetal monitoring.
Methods: We utlilised a health service perspective covering
randomisation to final maternal and neonatal discharge, including
readmissions. Primary analysis was intention to treat, with secondary
per protocol analysis. Post hoc analyses were conducted by
sub-groups and after exclusion of outliers. Main outcome
measure: Average cost per mother/baby dyad. Results: Costs
were calculated for 957/968 patients (98.9%) using hospital financial
data. There was no statistically significant evidence of difference
between the two study arms but lower costs observed in the STan arm.
Average cost per mother/baby dyad was AUD12,768 for Stan+CTG, compared
with AUD15,027 for CTG alone. Lower costs were mainly due to lower
neonatal costs, particularly for critical care. Maternal labour cost was
nearly identical in the two arms. The difference was still shown,
although with reduced magnitude, when outliers were removed and
increased with a per protocol analysis. Conclusion: While not
statistically significant, reduced costs were observed in the CTG+STan
arm (average reduction per mother / baby dyad = AUD2,259).