AN ECONOMIC-EVALUATION OF DAY-CARE IN THE MANAGEMENT OF HYPERTENSION IN PREGNANCY

Objective To evaluate the efficiency of daycare in the management of hypertension in pregnancy compared with inpatient management with prior domiciliary visits. Design Comparative study. Setting Two maternity teaching hospitals, Glasgow Royal Maternity Hospital which has an established daycare unit and Aberdeen Maternity Hospital with no day-care unit. Main outcome measures Pregnancy outcomes in terms of maternal hypertensive complications, gestation at delivery, mode of delivery, birthweight, Apgar scores, admission rates and length of admission to special care baby unit. Results There was no significant difference in any of the measured pregnancy outcomes between the two hospitals. The average cost of treating a woman with mild hypertension was 154.91 pounds in Glasgow and 136.59 pounds in Aberdeen. The average cost of treating women with a single episode of hypertension and women with a past history of hypertension was 88.65 pounds and 214.12 pounds in Glasgow and 31.18 pounds and 28.28 pounds in Aberdeen, respectively. If these two groups are excluded, the average cost of treating women with mild hypertension was 172.32 pounds in Glasgow and 201.13 pounds in Aberdeen. The majority of women were willing to attend daycare five times per week to avoid admission. Conclusion Daycare management of hypertension in pregnancy is more efficient than inpatient care with prior domiciliary visits for most women, but less efficient for women with transient or previous hypertension. It is very acceptable to women. Domiciliary checking of women with hypertension found at outpatient clinics would reduce resource use.