6 Screening and surveillance of pregnancy hypertension—an economic approach to the use of daycare

Summary

Frequent measurement of blood pressure is an accepted part of routine outpatient antenatal care. Women found to have mild hypertension may be further monitored for signs of progressive disease, while women with proteinuria or severe hypertension may be admitted for more intensive surveillance or treatment. In practice, the course and ultimate severity of this disorder are unpredictable and women with mild hypertension are frequently admitted. Recently, daycare has grown as an option for assessing women with hypertension as it offers the advantage of more extensive evaluation than is possible at an outpatient clinic and is widely assumed to be more cost-effective than conventional management. However, its use in obstetrics has not been subject to a formal economic appraisal. Such an evaluation is currently being carried out in two hospitals in Scotland, one of which uses daycare and inpatient admissions in the management of hypertension and one of which uses domiciliary midwife visits as well as hospital beds. Preliminary results suggest that the pregnancy outcome in terms of birthweight, gestation at delivery, admission to a special unit, etc., are the same in the two units for women with mild hypertension (diastolic 90–99 mmHg, no proteinuria). The costs per patient were less in the hospital with a daycare unit. These lower individual costs, however, do not mean that the overall costs to the health service are less in a hospital with daycare. This will depend on the average number of visits to daycare for women with mild hypertension, the proportion of hypertensive women receiving daycare, whether freed inpatient beds are closed or redeployed, and the capital costs of establishing a day unit. Data has also been collected on women's costs and views which will ultimately be presented and should play a part in any decision to implement or continue daycare.