1. Dublin, September 2012 Koen Putman, Lieven Annemans, Katrien Beeckman, Maaike Fobelets Health economic evaluation of the intervention (WP 5)

2. Concept In OptiBIRTH, health economic modelling will be used to estimate cost-effectiveness of the intervention. If VBAC is increased and this in turn reduces comorbidities after delivery, there will be possibly large economic benefits; The resulting net investment (initial investment minus future savings) will be balanced with the predicted health gain (expressed in avoided DALYs).

3. 1. To determine variation in costs between countries (base comparison) 2. To determine cost-effectiveness of the intervention, as measured in the RCT (WP4) Goals in WP5

4. What is a Health Economic Evaluation? The comparative analysis of alternative courses of action in terms of BOTH their costs and health consequences Related to OptiBIRTH: “standard care” vs OptiBIRTH programme

5. OptiBIRTH: costs Societal perspective –Health care perspective –Out-of-pocket contributions Time horizon: 6m post partum

6. OptiBIRTH: costs Costs –Direct medical costs –Direct non-medical costs (e.g. transport) –Indirect costs (e.g. # days away from work) –Intervention group: all costs associated with the programme

7. OptiBIRTH: data collection Direct medical costs –Inpatient hospital (claims) data –Diaries (women) Direct non-medical costs –Diaries (women) Indirect costs –Diaries, questionnaires (women)

8. OptiBIRTH: intervention Important note:  Only the resource use/costs related to implementing/running the programme need to be accounted for.

9. OptiBIRTH: intervention 1.To identify the relevant costs items associated with the intervention Time spent by (pre)implementation team Time spent by midwives/obstetricians Time spent by pregnant women Materials for launching and performing the program 2.To measure the costs in natural units 3.To assign a unit cost to each item

10. OptiBIRTH: Health consequences –DALY averted –OptiBIRTH: temporary YLD (6M) –Joint measure for mother and child

11. M1-M13: development of data collection sheets and translation into Italian and German M13: drafts sent to the national coordinators (PIs) (MHH, NUIG, UNIGE) and to AIMS for review and final approval M18 report on international comparison on variation of prenatal standard care between countries submitted M14-M20: data collection for pilot M21-M36: data collection for trial M36-M44: data analysis M45: comparison with main trial outcomes M45-48: report written Time line

12. To do’s in next 12 months Base comparison between countries –Inventory on organisation and financing aspects in perinatal care –Contact with country-PI’s for verification –Comparative matrix on “standard care” Preparation of materials for data collection –Materials in English –Translation –Data collection strategies

13. Health economic evaluation of the intervention (WP 5) Dublin, September 2012 Koen Putman kputman@vub.ac.be