Vaginal birth after cesarean delivery: An historic cohort cost analysis

At what price? a cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

“…The actual cost of providing a service is best estimated by identifying, measuring, and valuing all resources used in the production of the service [16], known as the ''bottom-up'' approach or micro-costing. Internationally, attempts have been made to estimate the delivery costs associated with a vaginal and caesarean delivery by determining direct medical costs [17]; direct and indirect medical costs, and fixed and variable costs [18]; hospital charges [19,20]; cost-to-charge ratios [21]; and per diem rates [22], with some studies including physician fees in their analysis [21,22]. However, due to this wide variety of costing techniques, these studies have reached divergent conclusions regarding estimated mode of delivery costs.…”

The Economics of Elective Cesarean Section

“…In each case in which investigators reported cost estimates of cesarean section with labor and without labor, the latter were always higher. 18,19,21,31 The restricted time horizon for all of the included studies likely results in an underestimate of costs for all types of deliveries due, in part, to the higher likelihood of repeat cesarean section. In a follow-up to the prior study of costs associated with initial delivery in a provincial database, Allen and colleagues 31 examined costs for each subsequent pregnancy.…”

General obstetrics: Vaginal birth after caesarean section versus elective repeat caesarean section: assessment of maternal downstream health outcomes

“…Cost and cost-effectiveness studies on trial of labour after a prior low transverse caesarean section have reached divergent conclusions when looking at the costs and the outcomes after only one delivery. [69][70][71] Interestingly, the only costeffectiveness study that modeled more than one pregnancy after the first caesarean section demonstrated that a policy of allowing a trial of labour leads to decreased maternal morbidity and decreased costs (even when incorporating long term neonatal outcomes). 72 Second, we did not include patient preferences in these models but suggest that physicians continue to incorporate preferences into decision making on an individual level.…”