Vaginal birth after cesarean delivery: an historic cohort cost analysis.
OBJECTIVE
The purpose of this study was to evaluate the relative cost-effectiveness of attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery.


METHODS
We performed an historic cohort analysis of women with a single prior cesarean delivery who were delivered at our institution during 1999. Inclusion criteria were > or =36 weeks' gestation and carrying a live, singleton fetus with no antenatally diagnosed anomalies. The primary outcome variable was mean cost of hospital care for mother-infant pairs, as obtained from the hospital's Clinical Resources Department.


RESULTS
The cohort consisted of 204 mother-infant pairs, 65 in the elective repeat cesarean group and 139 in the attempted vaginal birth group. Mean cost of care was higher for mothers ($4155 vs $3675;P <.001), neonates ($1794 vs $1187; P =.03), and mother-infant pairs ($5949 vs $4863; P =.001) for the elective repeat cesarean group compared with the attempted vaginal delivery group.


CONCLUSIONS
In women with a single prior cesarean delivery, a trial of labor is more cost-effective than an elective repeat cesarean delivery.
DiMaio
Heather
H
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Shands Hospital, University of Florida, Gainesville, USA.
Edwards
Rodney K
RK
Euliano
Tammy Y
TY
Treloar
R William
RW
Cruz
Amelia C
AC
D000328:Adult; D002585:Cesarean Section / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D016064:Vaginal Birth after Cesarean / Q000191:economics*