Tuesday, June 18, 2024

Comprehensive Review of Maternal-Perinatal Cost-Utility Analyses Highlights Need for Standardization

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The intricate dynamics of maternal-perinatal health interventions during pregnancy and childbirth significantly influence the health-related quality of life (HRQoL) of mothers, fetuses, and newborns. Despite this, existing cost-utility analyses (CUAs) in maternal-perinatal health frequently overlook the interconnectedness of maternal and child health outcomes. The challenges in accurately measuring and incorporating these outcomes, as well as their impact on the broader family unit’s HRQoL, remain a critical gap. This underscores the necessity for a holistic approach in evaluating maternal-perinatal interventions.

A systematic review was conducted to analyze methods for including the health outcomes of pregnant women, fetuses, and children in maternal-perinatal CUAs, as well as to assess how family spillover effects are incorporated.

Methodology and Scope

The review involved a comprehensive literature search across multiple databases including Medline, Embase, EconLit, Cochrane Collection, CINAHL, INAHTA, and PEDE, covering studies from their inception up to 2020, with an update extending to December 2022. Researchers extracted data on how health outcomes for mothers, fetuses, and children were measured, incorporated, and presented, along with any family spillover effects.

Key Findings

Out of 174 identified maternal-perinatal CUAs, 62 studies considered health outcomes for pregnant women and children. Among these, 54 were QALY-based CUAs, with only 12 including fetal health outcomes and their impact on maternal HRQoL. Specific studies highlighted the repercussions of fetal loss and neonatal demise on maternal HRQoL, yet the integration of these outcomes varied significantly. Notably, only one study out of 174 incorporated family spillover effects. The predominant approach measured health outcomes for mothers and children separately, often summing QALYs or DALYs for these groups.

The review revealed a clear disparity in how fetal losses were evaluated in terms of QALYs or DALYs and their subsequent impact on maternal HRQoL. The integration methods for these outcomes were inconsistent, with a common practice of reporting combined and incremental QALYs or DALYs at the family level.

Concrete Inferences for Stakeholders

– The majority of maternal-perinatal CUAs focus predominantly on mothers and children, often neglecting fetal health outcomes.

– Current practices lack consistency in measuring and integrating fetal losses and their impact on maternal HRQoL.

– Only a minimal number of studies consider family spillover effects, highlighting an area for significant improvement.

– There is a pressing need for standardized methods to enhance the reliability and comparability of maternal-perinatal CUAs.

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The review concludes that approximately one-third of maternal-perinatal CUAs comprehensively included health outcomes for mothers, fetuses, and children. Future CUAs should aim to adopt a societal perspective, incorporating these outcomes more rigorously. The diverse approaches identified call for standardized measurement and integration methods, which could lead to more reliable and high-quality evidence for decision-makers. Health Technology Assessment agencies are encouraged to provide structured guidance for future maternal-perinatal interventions.

Original Article: Pharmacoeconomics. 2024 May 31. doi: 10.1007/s40273-024-01397-5. Online ahead of print.

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