title: Cesarean delivery on demand: what will it cost?
abstract: OBJECTIVE
  The purpose of this study was to estimate the cost differences between elective cesarean delivery and the alternative of attempted vaginal delivery and to assess the economic impact of cesarean delivery on demand.
  
  
  METHODS
  Cost data were obtained over a 12-month period from a not-for-profit community hospital to calculate a per-patient cost for clinical alternatives.
  
  
  RESULTS
  The average cost of an attempted vaginal delivery without oxytocin (Pitocin) or epidural anesthesia was 15.1% lower in nulliparous women and 20% lower in multiparous women than with elective cesarean delivery. However, in nulliparous women, the addition of Pitocin nullified any cost differences; if epidural anesthesia was also used, total costs exceeded the cost of elective cesarean delivery by almost 10%. The cost of a failed attempt at vaginal delivery was much higher than elective cesarean delivery for both groups. The average cost for all women who attempted vaginal delivery was only 0.2% less than the per-patient cost of elective cesarean delivery.
  
  
  CONCLUSIONS
  The adoption of a policy of cesarean delivery on demand should have little impact on the overall cost of obstetric care.
authors.affiliation: Department of Economics and Finance, Lamar University, Beauville, Texas 77702, USA.
authors.forename: Brent W
authors.initials: BW
authors.lastname: Bost
mesh_terms: D000767:Anesthesia, Epidural / Q000191:economics; D000773:Anesthesia, Obstetrical / Q000191:economics; D002585:Cesarean Section / Q000191:economics*; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods; D017558:Elective Surgical Procedures / Q000191:economics*; D005260:Female; D006301:Health Services Needs and Demand; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000191:economics; D006788:Hospitals, Voluntary / Q000191:economics; D006801:Humans; D010121:Oxytocin / Q000191:economics; D010298:Parity; D011247:Pregnancy; D013781:Texas
chemical_list: D010121:Oxytocin