(1081) An increased postpartum visit model vs. the usual postpartum visit model: A cost-effectiveness analysis

The postpartum (PP) period is crucial for the health of both mothers and infants, necessitating comprehensive care. Traditional obstetrics care includes a routine postpartum follow-up visit at perhaps 2 to 6 weeks postpartum, but there is growing interest in exploring alternatives. A recent model which utilized Certified Nurse Midwives (CNMs) to provide more frequent PP visits was found to reduce both visits to the Emergency Department as well as hospital readmissions. The current study models the outcomes, costs, and cost-effectiveness of more frequent postpartum care versus a traditional obstetric care approach.

Study Design:

A decision-analytic model was created using TreeAgePro software to compare outcomes between using the frequent PP visit model versus the standard approach for postpartum follow-up visits. Our theoretical cohort was 2,356,883, the approximate number of postpartum individuals following low-risk vaginal deliveries annually in the US. Outcomes were emergency department visits, hospital readmissions, costs, and quality-adjusted life years (QALYs). All probabilities were derived from literature. The willingness to pay threshold was $100,000/QALY.

Results: In our cohort, the higher frequency care model was associated with 68,350 fewer emergency department visits (129,629 vs 197,978) and 683 fewer hospital readmissions (1296 vs 1980) (Table 1). There were $1,487,263,566 of increased costs with the higher frequency of visits model and it increased QALYs by 1217 (by 63,878,707 vs 63,877,490). The increased frequency model was not cost-effective with an ICER of $1,222,097/QALY. However, the model becomes cost effective when the costs were varied down to 50% or less of baseline assumed cost of 6 postpartum visits.

Conclusion:

The model of more frequent postpartum visits led to fewer ED visits and hospitalizations, but ultimately was not cost-effective. Whether the benefits from this high-frequency visit model would be realized from a virtual visit approach which would reduce costs should be investigated.