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Cost-effectiveness of a trial of labor after previous cesarean.
- Source :
-
Obstetrics and gynecology [Obstet Gynecol] 2001 Jun; Vol. 97 (6), pp. 932-41. - Publication Year :
- 2001
-
Abstract
- Objective: To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean.<br />Methods: We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective.<br />Results: The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as well as the probabilities of infant morbidity occurring, heavily impacted our results.<br />Conclusion: The cost-effectiveness of VBAC depends on the likelihood of successful trial of labor. Our modeling suggests that a trial of labor is cost-effective if the probability of successful vaginal delivery is greater than 0.74. Improved algorithms are needed to more precisely estimate the likelihood that a patient with a previous cesarean will have a successful vaginal delivery.
- Subjects :
- Adult
California
Cost-Benefit Analysis
Decision Trees
Female
Health Care Costs
Humans
Infant, Newborn
Models, Econometric
Obstetric Labor Complications epidemiology
Pregnancy
Risk Assessment
Sensitivity and Specificity
Infant Mortality trends
Obstetric Labor Complications economics
Pregnancy Outcome
Trial of Labor
Vaginal Birth after Cesarean economics
Vaginal Birth after Cesarean methods
Subjects
Details
- Language :
- English
- ISSN :
- 0029-7844
- Volume :
- 97
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Obstetrics and gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 11384699
- Full Text :
- https://doi.org/10.1016/s0029-7844(01)01355-2