Cost-effectiveness analysis of water immersion vs. epidural analgesia during labour. A ten-year study in the Balearic Islands, (Spain)

Value-based healthcare calls for selecting interventions that achieve optimal outcomes at the lowest cost. Although water immersion and epidural analgesia are effective for childbirth pain relief, few studies have compared their cost-effectiveness in real-world clinical settings.

This study aimed to evaluate the cost-effectiveness of water immersion compared to epidural analgesia during birth in a hospital setting.

A cost-analysis was undertaken. Data were drawn from a ten-year observational cohort study including 1,134 low-risk women. Healthcare costs were estimated according to the analgesic option chosen during labour, incorporating baseline costs, mode of birth, and any unexpected clinical events. For the water-immersion group, additional costs related to infrastructure adaptation and professional training were included to assess the return on investment. All costs were calculated using the public tariffs in force in the Balearic Islands.

Economically, the average cost per woman was €2,134 for water immersion versus €3,010 for epidural analgesia, with annual savings of €47,992. The initial investment in water immersion facilities was recovered within the first year.

These findings suggest that water immersion is a safe, effective, and cost-saving alternative to epidural analgesia. It aligns with value-based healthcare by improving outcomes, reducing interventions, and respecting women's preferences.

Policymakers and health managers should consider integrating water immersion as a standard pain management option in maternity services. Its implementation can enhance quality of care and optimise healthcare resource use, particularly in public systems aiming for sustainable, woman-centred models of intrapartum care.