title: Brief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.
abstract: BACKGROUND
  In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation.
  
  
  METHODS
  Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia.
  
  
  RESULTS
  From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled $8931 (2.5th-97.5th percentile prediction interval $8541-$9252). The cost was $9207 (2.5th-97.5th percentile prediction interval $8896-$9419) if ECV was attempted/performed without anesthesia. The expected mean incremental difference between the total cost of delivery that includes ECV with anesthesia and ECV without anesthesia was $-276 (2.5th-97.5th percentile prediction interval $-720 to $112).
  
  
  CONCLUSIONS
  The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.
authors.affiliation: Department of Anesthesia, H3580 Stanford University School of Medicine Stanford, California 94305, USA. bcarvalho@stanford.edu
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tan
authors.forename: Alex
authors.initials: A
authors.lastname: Macario
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.forename: Pervez
authors.initials: P
authors.lastname: Sultan
mesh_terms: D015360:Analgesia, Epidural / Q000191:economics* / Q000379:methods; D001946:Breech Presentation / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D003365:Costs and Cost Analysis / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000379:methods; D014710:Version, Fetal / Q000191:economics* / Q000379:methods