Economic evaluations and clinical decision making in obstetrical care

Controlling the increase of healthcare costs is a continuing and growing concern, especially in times of economic crisis and persistent deficits in government budgets. In the last decade health care costs have been growing faster than the Dutch economy itself. In 2012 the health care costs were €93 billion. In 2012 the Netherlands spent 15.4% of its gross domestic product on health care and welfare
Although pregnancy itself is generally not considered as a medical condition, pregnancy and delivery inevitably involve health care decisions, which affect maternal and neonatal outcomes, as well as costs. It is important, both for health care professionals and for policy makers, to have evidence on clinical
effectiveness as well as costs of available diagnostic and treatment strategies. Although the quality of the economic evaluations has improved over the last decades, the relevance of economic evaluations in the field of obstetrics is not fully acknowledged. The number of publications concerning economic evaluations in obstetrics during the past decades has not significantly increased. Furthermore, translation of the results of (cost-)effectiveness studies into the guidelines seems to be problematic.
The aim of the research reported in this thesis was to assess the effectiveness, costs and cost-effectiveness of a number of diagnostic and treatment strategies in obstetrical care. The resulting evidence can contribute to the development of clinical guidelines and evidence based policy making.