This study looks at the cost-effectiveness of the AFFIRM trial for women who experience a change in their baby’s movements.


The AFFIRM trial (which Sands contributed funding to) looked at whether making pregnant women and healthcare staff more aware of changes in babies’ movements could help to reduce stillbirths. In the trial, pregnant women were given a leaflet about noticing their baby’s movements and healthcare professionals received training to send women who noticed changes for an ultrasound scan to check whether the baby was growing as expected. If a woman was over 37 weeks pregnant and her baby’s movements changed more than once, she was offered a drug which would cause labour to start (induction of labour). The results showed that taking all of these steps (together called the AFFIRM ‘package of care’) reduced the rate of stillbirth by 11% on average. 

This study aims to assess the cost-effectiveness of the AFFIRM trial’s new package of care, looking at the financial cost per life saved and estimating the total costs and benefits of using the AFFIRM care package across the NHS. There is only a limited amount of money in the NHS budget and so the value for money needs to be calculated (how many lives are saved and how much this costs). This study aims to provide the evidence needed about the costs and benefits of the AFFIRM trial. See this infographic for a combined summary of the AFFIRM trial and this cost-effectiveness analysis trial.



More Information

Why was this research needed?

There is only a limited amount of money in the NHS budget and it is important that decisions around how cost-effective a part of care is are made fairly and based on good evidence. These choices are based on the number of people who will benefit from such care and the size of this benefit. Working out financial costs of delivering such parts of care is also crucial when considering whether they are good value for money. If someone were deciding whether to roll out the AFFIRM care package across the NHS, they would need evidence about its costs and benefits.


What were the aims of this study?

To determine the cost-effectiveness of the AFFIRM trial to see whether it could be used across the NHS.


What did the researchers do?

The researchers calculated the cost of providing the AFFIRM care package for one year. This was based on the costs of leaflets, staff training, and extra hospital visits, scans, and labour inductions that happened in the study. To work out the benefits of the care package, the number of perinatal deaths (stillbirths and babies who die in the first week of their life) that could be potentially prevented over a year was also estimated using data from the study.


What did the study find?

The study calculated that the best estimate of how much it would cost to provide the AFFIRM care package for one year across Great Britain is just under £62 million. This may sound like a lot of money, but is only 2.5% of the total maternity budget for one year and works out at less than £100 per birth. There are also costs for bereaved families, such as long-term health and financial impacts, which are important but have not been included in this analysis. The best estimate of the benefit of the AFFIRM care package is that it could prevent more than 320 perinatal deaths per year in Great Britain. This means that for AFFIRM, the estimated cost to prevent one perinatal death is around £190,000.

There is no predetermined amount of money that is considered to be “good value” to prevent perinatal deaths. However, for comparison the costs and benefits of AFFIRM are similar to the Saving Babies Lives Care Bundle which is already being promoted to all Trusts by NHS England. 


Additional information:

Lead researcher – Dr Elizabeth Camacho

Institution – University of Manchester

Amount awarded – £26,892 (additional funding provided by Tommy’s)

Duration – 2019 - 2022



AFFIRM trial research paper

AFFIRM trial cost-effectiveness research paper

Plain English summary



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