Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data

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Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data

Berg, Jenny (author): Swedish Agcy Hlth Technol Assessment & Assessment, Box 6183, SE-10233 Stockholm, Sweden.,Swedish Agency for Health Technology Assessment and Assessment of Social Services

Källén, Karin (author): Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Miljöepidemiologi,Forskargrupper vid Lunds universitet,Tornbladinstitutet,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Environmental Epidemiology,Lund University Research Groups,Tornblad Institute

Andolf, Ellika (author): Karolinska Institutet

Hellström-Westas, Lena, 1954- (author): Uppsala University,Uppsala universitet,Institutionen för kvinnors och barns hälsa

Ekéus, Cecilia (author): Uppsala University,Uppsala universitet,Institutionen för kvinnors och barns hälsa

Alvan, Jonatan (author): Swedish Agcy Hlth Technol Assessment & Assessment, Box 6183, SE-10233 Stockholm, Sweden.,Swedish Agency for Health Technology Assessment and Assessment of Social Services

Vitols, Sigurd (author): Karolinska Institutet,Swedish Agency for Health Technology Assessment and Assessment of Social Services

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Swedish Agcy Hlth Technol Assessment & Assessment, Box 6183, SE-10233 Stockholm, Sweden Swedish Agency for Health Technology Assessment and Assessment of Social Services (creator_code:org_t)

Elsevier BV, 2023
2023
English.
In: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 26:5, s. 639-648

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Journal article (peer-reviewed)

Abstract Subject headings

Objectives: There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs.Methods: We used the results from a systematic literature review of somatic risks for long-and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi-and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years.Results: Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses.Conclusions: CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short -and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Keyword

cesarean section on maternal request
economic evaluation
registry
Sweden
systematic review
cesarean section on maternal request
economic evaluation
registry
Sweden
systematic review

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art (subject category)

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By the author/editor: Berg, Jenny; Källén, Karin; Andolf, Ellika; Hellström-Westas ...; Ekéus, Cecilia; Alvan, Jonatan; show more...; Vitols, Sigurd; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Obstetrics Gynae ...

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By the university: Uppsala University; Lund University; Karolinska Institutet

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