Jun 1, 2001

Cost-effectiveness of a trial of labor after previous cesarean

Obstetrics and Gynecology
A ChungMaurice L Druzin

Abstract

To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean. We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective. The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as...Continue Reading

  • References16
  • Citations19

References

  • References16
  • Citations19

Citations

Mentioned in this Paper

Impacted Tooth
Cost Effectiveness
Vaginal Birth After Cesarean
Treatment Costs
Postneonatal Mortality
Pregnancy Outcome
Trial of Labor
Decision Trees
Obstetric Labor Complications
Vagina

About this Paper

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