Cost-effectiveness of refugee midwifery group practice in reducing preterm birth among women from refugee backgrounds in Australia

BACKGROUND: Globally, approximately 13.4 million babies were born prematurely in 2020, highlighting the widespread scale and importance of addressing preterm birth, especially within vulnerable populations such as women from refugee backgrounds. We aimed to assess the cost-effectiveness of a refugee midwifery group practice (RMGP) from a healthcare system perspective. METHODS: We developed a decision model using TreeAge Pro Healthcare 2024 to evaluate the cost-effectiveness of RMGP. Model parameters were sourced from the Australian RMGP data and published epidemiological evidence. Costs were estimated using the Medicare Benefit Scheme and the Australian Refined Diagnostic Groups and valued in 2025 Australian dollars (AUD). We calculated incremental cost-effectiveness ratios per preterm birth averted and conducted sensitivity analyses to assess the robustness of the results to variations in key model parameters. RESULTS: The average cost per birth was lower with RMGP than with standard care (AUD 11,214 vs AUD 16,152). In a cohort of 1000 pregnancies, RMGP was projected to result in 60 preterm births compared with 100 under standard care, 40 fewer preterm births per 1000 women. This resulted in cost savings of AUD 4937 per woman and demonstrated dominance. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH: The RMGP model yields better outcomes at a lower cost per woman than standard care. This result demonstrates that RMGP is a potentially cost-effective maternal healthcare intervention in reducing preterm birth.