title: Willingness or unwillingness to perform cesarean section for impending preterm delivery at 24 weeks' gestation: a cost-effectiveness analysis.
abstract: OBJECTIVE
  This study was undertaken to compare the costs and health outcomes of 2 management options when encountering a 24-week gestation in labor.
  
  
  METHODS
  We constructed a decision model for willingness versus unwillingness to perform cesarean section for fetal indication (aggressive vs nonaggressive management). We modeled chance nodes for stillbirth, neonatal death, and long-term survival, with and without major morbidity. Main outcome measures were intact (healthy) infant and live infant. Cost-effectiveness analysis was conducted from a societal perspective to determine the cost-effectiveness of the 2 strategies.
  
  
  RESULTS
  The probabilities of both intact survival (16.8% vs 12.9%) and survival with major morbidity (39.2% vs 19.4%) were higher with willingness to perform cesarean section. Nonaggressive management was less costly for delivery at 24 weeks' gestation. Aggressive management strategy would cost dollar 4,680,387 more than nonaggressive management for each additional intact infant, and dollar 766,241 more per additional live infant.
  
  
  CONCLUSIONS
  Although the probability of survival is increased by physician willingness to perform cesarean section, the more cost-effective strategy is unwillingness because of a strong relationship to the increased probability of survival with major morbidity when physicians are willing to perform cesarean section for fetal indications.
authors.affiliation: University of Michigan Health Systems, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA.
authors.forename: Gianina
authors.initials: G
authors.lastname: Cazan-London
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Mozurkewich
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Scott B
authors.initials: SB
authors.lastname: Ransom
mesh_terms: D002585:Cesarean Section; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics; D011262:Pregnancy Trimester, Second; D047928:Premature Birth; D011336:Probability