TY - JOUR
T1 - Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section
AU - Fobelets, M.
AU - Beeckman, K.
AU - Healy, P.
AU - Grylka-Baeschlin, S.
AU - Nicoletti, J.
AU - Devane, D.
AU - Gross, M. M.
AU - Morano, S.
AU - Daly, D.
AU - Begley, C.
AU - Putman, K.
N1 - Publisher Copyright:
© 2019 Royal College of Obstetricians and Gynaecologists
PY - 2019/7
Y1 - 2019/7
N2 - 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 lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services 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 cost–utility ratios were calculated per country. Results: The 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. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.
AB - 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 lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services 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 cost–utility ratios were calculated per country. Results: The 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. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.
KW - Cost-effectiveness analysis
KW - elective repeat caesarean
KW - quality of life
KW - vaginal birth after caesarean
UR - https://www.scopus.com/pages/publications/85064015348
U2 - 10.1111/1471-0528.15673
DO - 10.1111/1471-0528.15673
M3 - Article
C2 - 30957402
AN - SCOPUS:85064015348
SN - 1470-0328
VL - 126
SP - 1043
EP - 1051
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 8
ER -
