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IntroductionStillbirth continues to be a public health concern in high-income countries, and with mixed results from several stillbirth prevention interventions worldwide the need for an effective prevention method is ever present. The Safer Baby Bundle (SBB) proposes five evidence-based care packages shown to reduce stillbirth when implemented individually, and therefore are anticipated to produce significantly better outcomes if grouped together. This protocol describes the planned economic evaluation of the SBB quality improvement initiative in Australia.Methods and analysisThe implementation of the SBB will occur over three state-based health jurisdictions in Australia—New South Wales, Queensland and Victoria, from July 2019 onwards. The intervention is being applied at the state level, with sites opting to participate or not, and no individual woman recruitment. The economic evaluation will be based on a whole-of-population linked administrative dataset, which will include the data of all mothers, and their resultant children, who gave birth between 1 January 2016 and 31 December 2023 in these states, covering the preimplementation and postimplementation time period. The primary health outcome for this economic evaluation is late gestation stillbirths, with the secondary outcomes including but not limited to neonatal death, gestation at birth, mode of birth, admission to special care nursery and neonatal intensive care unit, and physical and mental health conditions for mother and child. Costs associated with all healthcare use from birth to 5 years post partum will be included for all women and children. A cost-effectiveness analysis will be undertaken using a difference-in-difference analysis approach to compare the primary outcome (late gestation stillbirth) and total costs for women before and after the implementation of the bundle.Ethics and disseminationEthics approval for the SBB project was provided by the Royal Brisbane & Women’s Hospital Human Research Ethics Committee (approval number: HREC/2019/QRBW/47709). Approval for the extraction of data to be used for the economic evaluation was granted by the New South Wales Population and Health Services Research Ethics Committee (approval number: 2020/ETH00684/2020.11), Australian Institute of Health and Welfare Human Research Ethics Committee (approval number: EO2020/4/1167), and Public Health Approval (approval number: PHA 20.00684) was also granted. Dissemination will occur via publication in peer reviewed journals, presentation at clinical and policy-focused conferences and meetings, and through the authors’ clinical and policy networks.This study will provide evidence around the cost effectiveness of a quality improvement initiative to prevent stillbirth, identifying the impact on health service use during pregnancy and long-term health service use of children.

ObjectiveThe aim of this review was to identify and describe whether parents who have had to stop paid employment to care for a child with a chronic condition or disability are eligible for unemployment, family and children, and disability and carer government-provided financial benefits.DesignPolicy review.SettingGroup of seven high-income countries.Main outcome measuresAll policies related to unemployment, family and children, and disability and carer benefits were included. Information regarding the policy type and description, parent/carer qualification, amount of financial support payable, eligibility criteria and information source were extracted. Payment schedules were converted into 2020 US dollars, using Purchasing Power Parities. Maximum monthly benefit payments were compared with standardised per capita monthly costs of living to determine payment support suitability.ResultsFifty-eight policies relevant to unemployment, family and children, and disability and carer benefit supports were identified. Germany had the highest number of welfare policies for individuals not in employment (n=11), followed by the USA (n=6). Parents or carers of children with chronic conditions or disability who were not in employment qualified for 31 of the 58 policies (53.4%). Most policies required a child to have an impaired ability to function, not just a chronic condition or disability.ConclusionsGreater support for parents and carers to continue their paid employment alongside caring responsibilities is necessary. Graded benefit schedules will also be critical to supporting the spectrum of childhood chronic conditions and disability, and the subsequent spectrum of caring responsibility.

Magnesium sulfate given to women before birth at <30 weeks’ gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme, an average of 86% of babies delivered at <30 weeks’ gestation were exposed to antenatal magnesium sulfate compared with a historical baseline rate of 63%. Our study strengthens the case for embedding quality improvement programmes in maternal perinatal care to reduce the impact of cerebral palsy on families and society.

Polycystic ovary syndrome (PCOS) affects up to one-in-five reproductive-aged women and its global healthcare-related economic burden is substantial. The aim of this review was to summarise evidence of the cost-effectiveness of interventions related to the treatment of women with PCOS. Six academic databases were systematically searched for relevant records. Cost data were extracted, and an interpretation statement was provided for each study based upon the cost difference or incremental cost-effectiveness ratio, and its statistical significance. The search yielded 10 relevant studies. Only one study was conducted in a low- and middle-income country (LMIC), China. Nine studies focused on infertility treatment, and one study related to pregnancy care. There remains uncertainty regarding cost-effectiveness of the following infertility treatments: In vitro fertilisation (IVF) cycles compared to ovulation induction (OI) cycles in women with clomiphene citrate (CC) resistant PCOS; and urinary follicle stimulating hormone compared to recombinant follicle stimulating hormone for OI. There are likely cost savings associated with laparoscopic ovarian drilling compared to OI with gonadotropins in women with CC-resistant PCOS, as well as with artificial cycle-frozen embryo transfer (AC-FET) without gonadotropin releasing hormone agonist (GnRH-a) pre-treatment compared to AC-FET with GnRH-a pre-treatment in women with PCOS. Treatment with metformin was lower cost and more effective compared to no treatment for achieving normal glucose regulation without developing gestational diabetes mellitus. The high proportion of fertility-related treatment studies reflects reproductive features often being the best-recognised feature of PCOS. However, limited evidence is available from LMICs. Further economic evidence is needed regarding PCOS treatments, particularly lifestyle interventions treating outcomes other than infertility.