116 Chapter 5 Figure 2: Break-even point actual costs versus reimbursement The orange line represents the actual costs of MLC-aCTG per year, the blue line represents reimbursed costs of MLC-aCTG per year and black lines represent the number of aCTG at which actual and reimbursed costs are equal. MLC-aCTG, midwife-led care antenatal cardiotocograph; OLC-aCTG, obstetrician-led care aCTG DISCUSSION As far as we know, this is the first study in which the budget impact has been assessed of implementing aCTG in primary care. The results of the base-case analysis suggest that, based on the best information available, implementing MLC-aCTG would result in an increase in actual costs of €311763 and €1247052 for implementation rates of 25% and 100%, respectively, and a decrease in reimbursement of almost €7538335 and €30 153 342million per year, for implementation rates of 25% and 100%, respectively. Our study focused on healthy pregnant women with a specific aCTG indication who received the aCTG in primary care as an alternative to temporary hospital admission during which an aCTG is conducted. Several studies of other innovations in maternity care focussing on out-of-hospital care for high-risk pregnancies had evaluated similar interventions. The trial of Bekker et al suggests that home telemonitoring of CTG and blood pressure measurements in pregnancy care is an acceptable alternative to monitoring selected women with complications in hospital, and therefore, has the potential to reduce admissions and costs in obstetric care.4 van den Heuvel et al reported that using a digital platform for blood pressure and symptom monitoring in antenatal care for high-risk women is associated with
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