Valuing fetal health outcomes in cost-effectiveness analysis (360G-Wellcome-217826_Z_19_Z)

Medical interventions used in pregnancy can affect the length and quality of life of both the woman and fetus. In cost-effectiveness analysis these effects are measured using quality-adjusted life years (QALYs), but fetal outcomes are rarely measured in QALYs, despite being an important clinical outcome. This exclusion will inevitably alter the perceived cost-effectiveness of interventions. I propose QALYs should be used in this setting to support consistent decision making across healthcare, but that how fetal QALYs are valued may differ from the value used for other patients. The aim of this doctoral studentship is to investigate whether QALYs could be applied to fetal outcomes when evaluating the cost-effectiveness of interventions in pregnancy, and how those QALYs should be valued. The project will take the preferences of pregnant women as its starting point, using secondary analysis of interviews with women experiencing high-risk pregnancies, qualitative focus groups, and a discrete choice experiment to first conceptualise and then quantify possible values that could be used in cost-effectiveness analysis. The outcomes of the project will be a valuation based on maternal preferences, which could be used to make resource allocation decisions in pregnancy, while also opening the door to further research in this setting.