A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies

Area of Science:

• Medical Education
• Health Economics
• Obstetrics

Background:

• Permanent obstetric brachial plexus injuries (OBPIs) are a significant complication of childbirth.
• Simulation training programs like Practical Obstetric Multi-Professional Training (PROMPT) aim to improve management of obstetric emergencies.
• The cost-effectiveness of widespread PROMPT implementation, particularly concerning OBPIs, requires thorough evaluation.

Purpose of the Study:

• To determine the cost-utility of a multi-professional simulation training program for obstetric emergencies (PROMPT).
• To specifically assess the impact of PROMPT on preventing permanent obstetric brachial plexus injuries (OBPIs).
• To compare the cost-effectiveness of national PROMPT implementation versus current practices.

Main Methods:

• A model-based cost-utility analysis using a decision tree model.
• Simulated cohorts of individuals affected by permanent OBPIs over a 30-year time horizon.
• Probabilistic sensitivity analysis to assess uncertainties in model parameters from an English NHS perspective.

Main Results:

• Nationwide PROMPT or shoulder dystocia training is projected to save over £1 billion compared to current practice.
• The training is associated with significant cost-savings, exceeding £1 million per quality-adjusted life year (QALY) gained.
• Probabilistic sensitivity analysis confirmed the cost-saving nature of national implementation.

Conclusions:

• National implementation of multi-professional simulation training for obstetric emergencies (PROMPT) is cost-saving.
• This approach effectively reduces the incidence of permanent OBPIs.
• Simulation training offers a cost-effective strategy for improving obstetric care and patient outcomes.