The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial.
BACKGROUND
The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery.


METHODS
We used a third-party-payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (< or = 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations.


RESULTS
The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth (7165 dollars v. 8042 dollars per mother and infant; mean difference -877 dollars, 95% credible interval -1286 dollars to -473 dollars). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth (7255 dollars v. 8440 dollars) and women having had at least one prior birth (7071 dollars v. 7559 dollars). Although the treatment effect was largest in the subgroup of women having their first child, there was no statistically significant interaction between treatment and parity since the 95% credible intervals for difference in treatment effects between parity equalling zero and parity of one or greater all include zero.


CONCLUSIONS
Planned cesarean section was found to be less costly than planned vaginal birth for the singleton fetus in a breech presentation at term in the Term Breech Trial.
Palencia
Roberto
R
Maternal, Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health, University of Toronto, Toronto, Ont.
Gafni
Amiram
A
Hannah
Mary E
ME
Ross
Susan
S
Willan
Andrew R
AR
Hewson
Sheila
S
McKay
Darren
D
Hannah
Walter
W
Whyte
Hilary
H
Amankwah
Kofi
K
Cheng
Mary
M
Guselle
Patricia
P
Helewa
Michael
M
Hodnett
Ellen D
ED
Hutton
Eileen K
EK
Kung
Rose
R
Saigal
Saroj
S
D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome