A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital Jocelyn Toohill, MMid, Grad Dip Educ, Grad Cert Hlth Mgmt (Lecturer) a,n , Erika Turkstra, PhD (Senior Lecturer) b , Jenny Gamble, PhD (Associate Professor, Deputy Head of School) a , Paul A. Scuffham, PhD (Professor) c a School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith University, University Drive, Meadowbrook 4131, Australia b Health Technology Assessment, School of Medicine Griffith University, University Drive, Meadowbrook 4131, Australia c Health Economics, School of Medicine Griffith University, University Drive, Meadowbrook 4131, Australia article info Article history: Received 9 December 2010 Received in revised form 10 October 2011 Accepted 31 October 2011 Keywords: Midwifery Group Practice Birth centre Cost-effectiveness Continuity of carer abstract Objective: to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). Design: a prospective non-randomised trial. Setting: an Australian metropolitan hospital. Method: women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n ¼119) were recruited to the study. Women (MGP n ¼52 or standard care n ¼50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women’s diaries, handheld pregnancy health records, medical records and the hospital accounting system. Main outcome measures: health-care costs to the hospital and government. Analysis: generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. Findings: women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p o0.001) and the government ($AUD4,722 vs. $AUD5,641 p o0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. Conclusion: for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable. & 2011 Elsevier Ltd. All rights reserved. Introduction Midwifery service delivery models have a philosophy to provide continuity of woman-centred care. However implementation of these models is inconsistent within countries, and throughout the world. Variations include diversity in setting, midwife to woman ratio, duration and number of visits, length of hospital stay, gestation at booking and duration of care after birth. Consequently the most cost-effective model is unknown (Henderson and Petrou, 2008). In Australia, team midwifery incorporating antenatal care in a community setting (Homer et al., 2001) and Midwifery Group Practice in a stand-alone unit have been found to be cost effective (Tracy and Hartz, 2006). A comparison of birth centre care alongside a tertiary level conventional delivery suite found no difference in costs (Byrne et al., 2000). However, rostered team midwifery in a stand-alone birth centre showed slightly higher birth costs compared with public hospital birth (Senate Community Affairs Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2011.10.012 n Corresponding author. E-mail addresses: j.toohill@griffith.edu.au, jtoohill@yahoo.com.au (J. Toohill), e.turkstra@griffith.edu.au (E. Turkstra), j.gamble@griffith.edu.au (J. Gamble), p.scuffham@griffith.edu.au (P.A. Scuffham). Midwifery 28 (2012) e874–e879