Economic evaluation studies of obstetric interventions in high risk pregnancies

In this thesis we performed comparative costs and cost-effectiveness analyses for several clinical dilemmas in high risk pregnancies or deliveries, and explored practical and methodological issues in such research and to discuss the context of evidence-based policy making in relation to complex dilemmas in clinical practice. Three approaches were presented: trial based economic evaluations prospectively comparing two treatment options; a model based approach, allowing to evaluate health economic consequences of all subsequent pregnancies following a decision for a current mode of delivery; and a clinical prediction model to formalize clinical reasoning in screening and diagnostic interventions. In view of observed quality of current research in this area, there is still much potential for improvement. Finally, both with respect to promising methodological approaches as well as the health care policy context (research infrastructure, financial resources, legal framework), there is ample work to do in the near future by clinicians, researchers, policy makers and all other relevant parties. This is in line with the growing awareness among clinicians and policymakers that economic evaluation studies should become less one-off projects, but should be more structurally integrated in the health care system in order to counter unsustainable rising health care costs.