TITLE

The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial

AUTHOR(S)
Palencia, Roberto; Gafni, Amiram; Hannah, Mary E.; Ross, Susan; Willan, Andrew R.; Hewson, Sheila; McKay, Darren; Hannah, Walter; Whyte, Hilary; Amankwah, Kofi; Cheng, Mary; Guselle, Patricia; Helewa, Michael; Hodnett, Ellen D.; Hutton, Eileen K.; Kung, Rose
PUB. DATE
April 2006
SOURCE
CMAJ: Canadian Medical Association Journal;4/11/2006, Vol. 174 Issue 8, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery. Methods: We used a third-party--payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (£ 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations. Results: The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth ($7165 v. $8042 per mother and infant; mean difference -$877, 95% credible interval -$1286 to -$473). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth ($7255 v. $8440) and women having had at least one prior birth ($7071 v. $7559). Although the treatment effect was largest in the subgroup of women having their first child, there was no statistically significant interaction between treatment and parity since the 95% credible intervals for difference in treatment effects between parity equalling zero and parity of one or greater all include zero. Interpretation: Planned cesarean section was found to be less costly than planned vaginal birth for the singleton fetus in a breech presentation at term in the Term Breech Trial.
ACCESSION #
20879485

 

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