109 Budget impact analysis of aCTG in primary midwife-led care Survey For specific information about the costs in both MLC-aCTG and OLC-aCTG, we developed an online questionnaire in the Castor Electronic Data Capture system.17 A link to the questionnaire was sent to healthcare professionals and financial staff working in MLC or OLC in the three regional maternity care networks included in the prospective cohort study between July and October 2020. We asked for details about the healthcare provider’s work setting (eg, midwifery practice, midwifery cooperation, hospital), healthcare capacity (eg, number of aCTGs performed, type of indications of aCTG, workload) and financial information (eg, reimbursed costs, equipment costs and other overhead costs). All data were reported anonymously, and references to the identity of the participants were deleted before analysis. Data-Infrastructure for Parents and Children database The Data-Infrastructure for Parents and Children (DIAPER) database was used to obtain information about the OLC-aCTG reimbursement. The DIAPER database links data from various sources (Vektis, Perined and Statistics Netherlands) within a secure environment.18 DIAPER contains detailed reporting information on reimbursement from health insurers related to pregnancy, childbirth and maternity care (Vektis),19 data about the quality of care, health outcomes of pregnant women and newborns (Perined),20 and background characteristics of mother and child (Statistics Netherlands).21 For the purpose of this study, we only used data from Perined and Vektis for the years 2016–2020 (4 years). All data were anonymised. Actual costs MLC-aCTG actual costs were those incurred by midwifery practices, or at communitybased ultrasound centres and were calculated by summing costs related to performing aCTGs and overhead costs (online supplemental material 1, worksheet ‘care pathways costs’). Time costs were calculated by multiplying the prevalence of performing a reassuring and a non-reassuring aCTG by the time spent on an aCTG by the healthcare professionals by their hourly wage (time-driven activity costing). Healthcare professionals’ hourly wages were based on data from the Royal Dutch Organisation of Midwives,22 the Dutch Association of Hospitals23 and the Dutch guideline for conducting economic evaluations in healthcare.14 Hospital admission day costs were based on the Dutch costing manual.24 Overhead costs were calculated by summing costs related to equipment, training and quality assessment. Market prices of equipment were first depreciated over 10 years with an interest rate of 4.2% as recommended by the Dutch guideline for conducting economic evaluations in healthcare.14 Subsequently, the estimated yearly equipment costs were multiplied by the number of available types of equipment in the prospective cohort and divided by the number of pregnant women in the maternity care network per year. Training costs and quality assessment costs were estimated based on data from the survey and the prospective cohort study (online supplemental material 1, worksheet ‘care 5
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