Cost-effectiveness analysis of natural birth and elective C-section in supplemental health

Abstract

OBJECTIVE To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women.METHODS The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators’ pricing tables, and pricing reference publications of health resources.RESULTS Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population.CONCLUSIONS It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.

Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System

“…Promoting vaginal deliveries is also cost-beneficial since a recent analysis performed in Brazil showed that natural childbirth was more cost-effective than elective CS for primiparous normal risk pregnant women. This conclusion did not apply, however, for multiparous women with previous uterine scar [23]. Compared to a previous investigation performed in 2017 in our clinic, which revealed that young women were more likely to give birth by CS at any age group [24], our present results show a modest but encouraging increase in vaginal delivery rates among teenagers.…”

Misgav‐Ladach or modified Misgav‐Ladach versus Pfannenstiel‐Kerr methods for cesarean deliveries: A systematic review and meta‐analysis

“…Additionally, the length of hospital stay has been proven to have a large impact on overall hospital costs, with the cost of a 36 h postnatal stay for a mother in the United Kingdom averaging £692 56 . Similarly, a study completed in the United States showed the average daily cost for postnatal stay being $544.65 57 . Decreasing the length of hospital stay would significantly decrease the hospital cost per mother.…”

Cost analysis - the desirability of natural delivery and caesarean section with decision tree model

“…In our research, the mean and standard deviation of the total cost for natural delivery and cesarean section were 26980930.90±16603206.35 and 6126709.15±48883938.59, respectively. In the research of Alain Pivozan Intriger and her colleagues, it was observed that natural delivery was less expensive for primiparous pregnant women compared to elective cesarean section ($5,210.96 versus $5,753.54) (29). An increase in cesarean delivery increases direct payments and out-of-pocket costs and dramatically undermines the sustainability of health care systems.…”