(490) Cost-effectiveness of External Fetal and Maternal Heart Rate Monitoring vs. External Fetal Heart Rate Alone

Standard observation of a fetus during labor involves the use of external fetal monitoring to track fetal status. Recent evidence suggests that dual monitoring of external fetal heart rate (FHR) with concurrent maternal heart rate (MHR) can reduce the incidence of adverse neonatal outcomes. This study examined the cost-effectiveness of concurrent MHR and FHR monitoring during labor.

Study Design:

We constructed a decision-analytic model using TreeAge Pro to compare neonatal outcomes between external FHR monitoring alone and dual external FHR and MHR monitoring. Outcomes examined included cost, neurodevelopmental delay (NDD), encephalopathy, death, NICU admission, and quality-adjusted life years (QALYs). The theoretical cohort was 2,512,945 patients, the estimated annual singleton vaginal births at term. We applied a willingness-to-pay threshold of $100,000 per QALY for the incremental cost-effectiveness ratio (ICER). The model inputs were sourced from literature and the QALYs were calculated using a 3% discount rate.

Results: In our theoretical cohort of 2,512,945 patients, dual MHR and FHR saved $843,454,354 and increased QALYs by 37,644. There would be 223 fewer patients with NDD, 1,131 fewer patients with encephalopathy, 8,325 fewer NICU admissions, and 291 fewer neonatal deaths. The negative ICER of $-22,406/QALY suggests that not only is this strategy more effective, but also cost-saving. Univariate sensitivity analysis of neonatal encephalopathy indicates that the dual monitoring would be cost-saving once the probability of encephalopathy exceeds 0.06% (Figure 1).
 

Conclusion: In our study, the use of dual external FHR and MHR monitoring during labor is a cost-saving strategy when compared to external FHR monitoring alone. Standardizing labor protocols to include external MHR monitoring may reduce dire neonatal outcomes.