Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section

• Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services perspectives, using a decision tree. Main outcome measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95%CI €258–268) and 0.008QALYs (95%CI 0.008–0.009QALYs) for Germany, €456 (95%CI €448–464) and 0.052QALYs (95%CI 0.051–0.053QALYs) for Ireland, and €1174 (95%CI €1170–1178) and 0.006QALYs (95%CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. © 2019 Royal College of Obstetricians and Gynaecologists

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

Nyckelord

Cost-effectiveness analysis

elective repeat caesarean

quality of life

vaginal birth after caesarean

adult

article

childbirth

controlled study

cost effectiveness analysis

cost utility analysis

decision tree

female

Germany

human

human experiment

infant

Ireland

Italy

mortality

newborn morbidity

outcome assessment

pregnancy

pregnant woman

probability

quality adjusted life year

randomized controlled trial

sensitivity analysis

vaginal birth after cesarean

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)