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Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2292 (Published 19 April 2012) Cite this as: BMJ 2012;344:e2292

Re: Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study

It appears that the findings of this study are so restrictive as to render any conclusions highly doubtful.

First, as the authors acknowledge in the supporting materials, they did not take into account long term costs. In the case of adverse outcomes, the cost of caring for the medical needs of a disabled child, and the cost of any legal settlement dwarf other costs by orders of magnitude. In the absence of data about long term costs, it is impossible to reach conclusions about cost effectiveness.

Second, the eligibility criteria for inclusion in the study are far more strict than the actual eligibility requirements for homebirth in the UK. While the authors may have reached a conclusion about the women and babies in the study, they haven't even investigated the actual costs of homebirth in the UK, only a subset of homebirths that meet stricter requirements.

In other words, the authors have found that in an ideal homebirth population, short term costs may be slightly lower for homebirth than for hospital birth. However, the real issue is the long term costs in a real world population. Without that, no conclusion can be drawn about the cost effectiveness of homebirth.

Competing interests: No competing interests
21 April 2012
Amy Tuteur, MD
obstetrician
self-employed
Boston, MA
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