Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries

Fobelets, Maaike; Beeckman, Katrien; Faron, Gilles; Daly, Déirdre; Begley, Cecily; Putman, Koen

doi:10.1186/s12884-018-1720-6

Cited by 29 publications

(29 citation statements)

References 44 publications

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“…When described, it was set at US$50,000 (9), US$100,000 (2), US$50,000‐100,000 (2), UK£20,000 (€22,753) (2) and €45,000 (2), equivalent to US$32,000 and US$63,000 at the time of publication. One study that considered four European countries, described country‐specific thresholds that were equivalent to three countries’ gross domestic product (37,719 € for Germany, €36,633 for Belgium and €27,219 for Italy) while that for Ireland was set at €45,000 …”

Section: Resultsmentioning

confidence: 99%

Clinical decision analysis and model‐based economic evaluation studies in perinatology: A systematic review

D’Souza

Bonasia

Shah

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Perinatology, the study of two individuals that constitute the mother‐fetus dyad, poses unique challenges to the conduct of clinical decision analysis (CDA) and economic evaluation (EE) studies. Our objective was systematically to review CDA and model‐based EE studies in pregnant women to better understand how these studies have been conducted and reported in perinatology. Material and methods MEDLINE, Embase, Scopus, Web of Science and clinicaltrials.gov were searched as of October 2018. The indexing terms “pregnancy”, “decision trees”, “Markov models” and “economic models” were used. The search was limited to human data and the English language. Two reviewers independently screened titles and abstracts. Data extraction and assessment of reporting quality were performed in duplicate for 10% of studies and reached 100% agreement. The remainder was carried out by a single reviewer. The study protocol was registered with PROSPERO (CRD 42016047206). Results Seventy‐seven studies met eligibility criteria and fulfilled between 40% and 91% of relevant attributes on the checklist for critical appraisal of CDA models. There was considerable variation in study reporting. A total of 53% of studies included maternal and offspring outcomes, 14% described using weighted means, meta‐analyses or health administrative databases to estimate probabilities and 13% considered outcomes over the lifetime of mother and offspring. Patient preferences (utilities) were used in 47% of the studies. Of these, 10% were elicited from healthcare providers alone and not from pregnant women or the public. Of the EE studies, 25% described a societal analytic perspective. Where relevant, 42% described discounting for costs and benefits, and 30% reported using probabilistic and deterministic sensitivity analyses. Conclusions Despite long‐term implications of perinatal decisions to mother and offspring, CDA and model‐based EE studies in perinatology frequently do not consider lifetime horizons and patient‐preferences for outcomes related to mother and offspring. They also often fail to adhere to guidelines regarding conduct and reporting.

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Section: Resultsmentioning

confidence: 99%

Clinical decision analysis and model‐based economic evaluation studies in perinatology: A systematic review

D’Souza

Bonasia

Shah

et al. 2019

Acta Obstet Gynecol Scand

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“…Other neonatal outcomes examined (admission to NICU, and preterm birth) also did not differ significantly between the two groups. Separate economic analysis showed that VBAC resulted in a cost reduction ranging from €3,334,052 (Germany) to €66,162,379 (Ireland) and gains in quality-adjusted life-years from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country [37]. Limitations of the OptiBIRTH cluster trial include missing data from 46 of the 2002 recruited women who moved away, or gave birth in another maternity unit (2.3%).…”

Section: Discussionmentioning

confidence: 99%

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

Clarke

Devane

Gross

et al. 2020

BMC Pregnancy Childbirth

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Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.(Continued on next page)

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“…Looking at these hypothetical cohort studies, two European studies were conducted comparing attempting a VBAC with ERCS . VBAC was found to be a dominant strategy in four EU countries (Belgium, Germany, Ireland, and Italy), resulting in a cost and utility gain, over ERCS using a 6‐week and lifetime time horizon.…”

Section: Discussionmentioning

confidence: 99%

“…A decision tree has been developed in the context of OptiBIRTH (Figure ) . The algorithm of the decision tree was similar for all three countries and consisted of two main arms: intervention and control.…”

Section: Methodsmentioning

confidence: 99%

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

Fobelets

Beeckman

Healy

et al. 2019

BJOG

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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 lowersegment caesarean section; sites were randomised (3:2) to intervention or control.Methods A cost-utility analysis from both societal and healthservices 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 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental costutility ratios were calculated per country. ResultsThe 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 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, €456 (95% CI €448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and €1174 (95% CI €1170-1178) and 0.006 QALYs (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. ConclusionThe OptiBIRTH intervention was likely to be costeffective in Ireland and Germany.Keywords Cost-effectiveness analysis, elective repeat caesarean, quality of life, vaginal birth after caesarean.Tweetable abstract The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.

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Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries

Cited by 29 publications

References 44 publications

Clinical decision analysis and model‐based economic evaluation studies in perinatology: A systematic review

Clinical decision analysis and model‐based economic evaluation studies in perinatology: A systematic review

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

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

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