Home-based care after a shortened hospital stay versus hospital-based care postpartum: an economic evaluation Stavros Petrou, a Michel Boulvain, b Judit Simon, a Patrice Maricot, c Franc ¸ois Borst, c Thomas Perneger, d Olivier Irion b Objectives To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting The University Hospital of Geneva and its catchment area. Population Four hundred and fifty-nine deliveries of a single infant at term following an uncomplicated pregnancy. Methods Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n ¼ 228) or a traditional postnatal hospital stay (n ¼ 231). Main outcome measures Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Results Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non-medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother–infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. Conclusions A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant. INTRODUCTION The postnatal length of stay following ‘normal’ delivery has declined in most industrialised countries in recent years, largely as a consequence of increased efforts to control health care costs and a popular trend towards demedicalising aspects of childbirth. 1 The relative benefits and risks associated with early postnatal discharge policies have been evaluated by eight randomised controlled trials to date, 2–9 of which only one included an economic evaluation. 6 That study compared an early discharge policy after unplanned caesarean delivery, accompanied by a minimum of two home visits and 10 telephone calls, with standard care in hospital without follow up at home. The early discharge policy resulted in substantial savings to health care providers. However, application of hospital charges rather than costs is likely to have resulted in an over-estimation of the real savings that can be attributed to early discharge. Several economic analyses based on cohort studies or case series have concluded that the economic value of the resources released by early postnatal discharge are not offset by increased costs to other sectors of the health service or the wider economy. 10 – 20 However, in addition to basing assessments of the efficacy of early postnatal discharge policies on observational evidence, these economic analyses BJOG: an International Journal of Obstetrics and Gynaecology August 2004, Vol. 111, pp. 800–806 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog a National Perinatal Epidemiology Unit, Institute of Health Sciences, University of Oxford, UK b Department of Obstetrics and Gynaecology, Geneva University Hospitals, University of Geneva, Switzerland c Unit of Health Economic Information, Geneva University Hospitals, University of Geneva, Switzerland d Quality of Care Unit, Geneva University Hospitals, University of Geneva, Switzerland Correspondence: Dr S. Petrou, National Perinatal Epidemiology Unit, Institute of Health Sciences, University of Oxford, Old Road, Headington, Oxford OX3 7LF, England, UK. DOI:10.1111/j.1471-0528.2004.00173.x