At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

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dc.contributor.authorFawsitt, Christopher G.
dc.contributor.authorBourke, Jane
dc.contributor.authorGreene, Richard A.
dc.contributor.authorEverard, Claire M.
dc.contributor.authorMurphy, Aileen
dc.contributor.authorLutomski, Jennifer E.
dc.contributor.funderNational Perinatal Epidemiology Centre, College of Medicine and Health, University College Cork
dc.date.accessioned2014-10-01T14:15:00Z
dc.date.available2014-10-01T14:15:00Z
dc.date.issued2013-03-06
dc.date.updated2014-09-01T10:29:25Z
dc.description.abstractBackground: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFawsitt, C. G., Bourke, J., Greene, R. A., Everard, C. M., Murphy, A., Lutomski, J. E. (2013) 'At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery', PLOS ONE, 8(3), e58577 (8pp). doi: 10.1371/journal.pone.0058577en
dc.identifier.doi10.1371/journal.pone.0058577
dc.identifier.issn1932-6203
dc.identifier.issued3en
dc.identifier.journaltitlePlos Oneen
dc.identifier.startpagee58577en
dc.identifier.urihttps://hdl.handle.net/10468/1681
dc.identifier.volume8en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.rights© 2013 Fawsitt et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectVaginal birthen
dc.subjectMaternal morbidityen
dc.subjectCaesarean sectionen
dc.subjectPregnancyen
dc.subjectCohorten
dc.subjectPlacenta accretaen
dc.subjectWomenen
dc.subjectOutcomesen
dc.subjectPregnanciesen
dc.subjectDiseaseen
dc.subjectMetaanalysisen
dc.titleAt what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean deliveryen
dc.typeArticle (peer-reviewed)en
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