110 Chapter 5 pathways costs’). To estimate the actual costs of performing an OLC-aCTG, we used the same approach as for MLC-aCTG. However, to calculate time costs for clinical work, we used hourly wages of healthcare professionals in the hospital (ie, obstetricians, obstetric residents, hospital-based midwives and nurses). Moreover, to account for the temporary admission of the pregnant woman, we estimated admission costs per hour of an admission day (online supplemental material 1, worksheet ‘care pathways costs’). All costs were indexed to 2020. Reimbursement MLC-aCTG reimbursement was defined as the weighted amount reimbursed to health insurance companies according to the Dutch Healthcare Authority when performing an aCTG.25 Reimbursement for the MLC-aCTG care path was weighted by the probability of having a reassuring or non-reassuring aCTG (online supplemental material 1, worksheet ‘care pathways costs’). To estimate the OLC-aCTG reimbursement, we extracted from Perined data of women from 28 weeks of gestation onwards who were referred once to OLC for reduced fetal movements for an aCTG consultation in the hospital and received further care in MLC. We excluded cases if, next to the consultation for reduced fetal movements, there were other consultations with the obstetrician or paediatrician, multiple pregnancies or missing identification numbers for linking Perined data to Vektis data. In the Vektis data, reimbursement for a medical specialist was extracted, and cases with missing identification number and parity information were excluded. After applying the inclusion and exclusion criteria, 9822 healthy women remained for the analyses. Subsequently, the Vektis and Perined data files were merged within the secure DIAPER environment by identification number and year of delivery. Descriptive statistics were used to report the OLC-aCTG reimbursement. Base-case analysis The budget impact of implementing MLC-aCTG on a national scale was estimated for three specific indications: reduced fetal movements, external cephalic version in MLC and postdate pregnancy in the Netherlands. The budget impact was estimated using the equation: Where N represents the estimated number of aCTGs performed per year, and and are the costs per patient per year related to both MLC-aCTG and OLC-aCTG, respectively. N was calculated as the product of the estimated number of healthy pregnant women in the Netherlands in 2020 and the annual prevalence of performing an aCTG for three specific indications. Different MLC-aCTG implementation rates of 25%, 50%, 75% and 100% were explored.
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