Economic evaluation and budget impact analysis of midwifery-led care for low-risk pregnancies in Portugal

BACKGROUND: Midwifery-led models of care for low-risk pregnancies are associated with improved outcomes for mothers and babies, without additional adverse effects. These models are also considered more cost-effective than doctor-led or shared-care approaches. PROBLEM: In Portugal, midwifery-led antenatal care is not widely implemented, and its economic impact remains unexplored. AIM: To estimate the cost implications of implementing a midwifery-led antenatal care model for low-risk pregnancies in Portugal, compared to standard doctor-led care, from the perspective of the Portuguese National Health Service. METHODS: A decision-tree model was developed to simulate the antenatal period through birth, comparing midwifery-led and doctor-led care. The eligible population included low-risk pregnant women. Outcomes included preterm birth, spontaneous vaginal birth, instrumental birth, and caesarean section. A budget impact analysis estimated the financial implications for the national health service. Sensitivity and scenario analyses tested the robustness of findings by varying key parameters and assumptions. FINDINGS: Midwifery-led care was estimated to cost €23.08 million, compared to €39.35 million for doctor-led care, resulting in projected savings of €16.27 million. Lower rates of preterm birth, instrumental deliveries, and caesarean sections, alongside increased spontaneous vaginal births, accounted for €10.07 million in cost-offsets. Total savings were estimated at €26.34 million, or €340 per pregnancy/birth, representing a 25.8 % reduction in maternity-related expenditure. DISCUSSION AND CONCLUSION: Midwifery-led care presents a promising, cost-saving alternative to the current standard of care in Portugal, with the potential to improve clinical outcomes and optimize resource use. Further research is needed to evaluate long-term economic and health impacts beyond birth.