A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis

BMC Medicine
Mira JohriNils Chaillet

Abstract

Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions. A prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3 months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clin...Continue Reading

References

Feb 3, 2005·Health Economics·Andrew BriggsSimon Thompson
Jun 7, 2006·Lancet·José VillarUNKNOWN WHO 2005 global survey on maternal and perinatal health research group
Jun 2, 2007·BMJ : British Medical Journal·Alan A MontgomeryUNKNOWN DiAMOND Study Group
Feb 6, 2010·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Sandra HollinghurstAlan Montgomery
Oct 22, 2011·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Manuel GomesSimon G Thompson
Dec 19, 2013·Statistical Methods in Medical Research·Edmond S-W NgJames R Carpenter
Mar 17, 2015·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Scott D RamseySean D Sullivan
Apr 30, 2015·The New England Journal of Medicine·Nils ChailletUNKNOWN QUARISMA Trial Research Group
Jun 22, 2015·Reproductive Health·Ana Pilar BetranAhmet Metin Gülmezoglu

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Citations

Aug 28, 2018·PloS One·Emmanuelle LesieurFlorence Bretelle
Sep 29, 2018·The Cochrane Database of Systematic Reviews·Innie ChenAna Pilar Betran
Dec 31, 2019·Paediatric and Perinatal Epidemiology·Emily J CallanderDavid Ellwood
Oct 8, 2019·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Hasan Onur TopçuYaprak Üstün

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Software Mentioned

QUARISMA
MLwiN
Stata

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