Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

Xu, Xiao; Ivy, Julie S.; Patel, Divya; Patel, S.; Smith, Dean G.; Ransom, Scott B.; Fenner, Dee E.; DeLancey, John O.L.

doi:10.1089/jwh.2009.1404

Cited by 29 publications

(17 citation statements)

References 107 publications

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“…Results in the NICE guidelines noted that a planned CS was less expensive than an unplanned CS [this finding is also noted in references and ]. Furthermore, the NICE guidelines conclude that unplanned CSs contribute to significantly more adverse maternal and infant outcomes compared with all other modes of birth.…”

Section: Resultsmentioning

confidence: 76%

Economics of childbirth

Fahy

Doyle

Denny

et al. 2013

Acta Obstet Gynecol Scand

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Section: Resultsmentioning

confidence: 76%

Economics of childbirth

Fahy

Doyle

Denny

et al. 2013

Acta Obstet Gynecol Scand

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“…Normal prenatal testing, composed of amniocentesis and chorionic villous sampling, had a utility value of 0.92 (21), and colposcopy or cervix biopsy was given a value of 0.89 (22). In addition, an instrumental vaginal delivery had a utility value of 0.76, whereas an emergency cesarean delivery had a utility value of 0.59 (23).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Breast Biopsy: Effect on Short-term Quality of Life

Humphrey¹,

Lee²,

Donelan³

et al. 2014

Radiology

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women undergoing percutaneous breast biopsy in an academic medical center were recruited to participate in a mixed-mode survey 2-4 days after biopsy. Patients described their biopsy experience by using the Testing Morbidities Index (TMI), a validated instrument for assessing short-term quality of life related to diagnostic testing. The scale ranged from 0 (worst possible experience) to 100 (no adverse effects). Seven attributes were assessed: pain or discomfort before and during testing, fear or anxiety before and during testing, embarrassment during testing, and physical and mental function after testing. Demographic and clinical information were also collected. Univariate and multivariate linear regression analyses were performed to identify significant predictors of TMI score. Results:In 188 women (mean age, 51.4 years; range, 22-80 years), the mean TMI score (6standard deviation) was 82 6 12. Univariate analysis revealed age and race as significant predictors of the TMI score (P , .05). In the multivariate model, only patient age remained a significant independent predictor (P = .001). TMI scores decreased by approximately three points for every decade decrease in patient age, which suggests that younger women were more adversely affected by the biopsy experience. Conclusion:Younger patient age is a significant predictor of decreased short-term quality of life related to percutaneous breast biopsy procedures. Tailored prebiopsy counseling may better prepare women for percutaneous biopsy procedures and improve their experience.q RSNA, 2013

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“…When data ranges were not available from the literature, we used +/−25% of the base value for the sensitivity analysis. 45 To demonstrate the potential net savings of immediate postpartum implant insertion, we also conducted a cost–benefit analysis by accounting for avoided costs associated with potential subsequent pregnancies from the health care system’s perspective. All analyses were conducted with TreeAge software (TreeAge Pro 2012, TreeAge Software, Inc., Williamstown, MA).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion

Gariepy

Duffy

2015

Obstetrics & Gynecology

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Objective To evaluate the cost-effectiveness of immediate versus delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy. Methods We constructed a decision-analytic model to examine a hypothetical population of women who request a contraceptive implant after giving birth. The timeframe for analysis was from the time of childbirth to one year postpartum. Model inputs were derived from a comprehensive literature review. We compared immediate (before discharge from the childbirth hospital stay) versus delayed (at first postpartum office visit) postpartum placement of the contraceptive implant from a health care system’s perspective. Implant insertion and removal, loss to follow-up at postpartum visit, use of alternative contraceptive methods, and contraceptive failure were incorporated into the model. We calculated the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented. One-way sensitivity analyses were also performed. Cost estimates are reported in 2014 U.S. dollars. Results Immediate postpartum implant insertion is associated with higher expected cost than delayed insertion ($1,091 per patient versus $650 per patient), but is more effective in preventing pregnancies (expected pregnancy rate: 2.4% and 21.6%, respectively). This results in an incremental cost-effectiveness ratio of $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient. Conclusions Immediate postpartum provision of the contraceptive implant is cost-effective in preventing unintended pregnancies, and should be provided to women requesting this form of contraception.

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Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis

Abstract: When a woman without medical/obstetric indications has only one childbirth in her lifetime, cost-effectiveness analysis does not reveal a clearly preferable mode of delivery.

Cited by 29 publications

References 107 publications

Economics of childbirth

Economics of childbirth

Percutaneous Breast Biopsy: Effect on Short-term Quality of Life

Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion

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