title: Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?
abstract: BACKGROUND
  External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery.
  
  
  METHODS
  In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS.
  
  
  RESULTS
  Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs.
  
  
  CONCLUSIONS
  The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine Hadassah-Hebrew, University Medical Center, Ein Kerem, Jerusalem 91120, Israel. carolynfweiniger@gmail.com.
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Weiniger
authors.forename: Paul S
authors.initials: PS
authors.lastname: Spencer
authors.forename: Yuval
authors.initials: Y
authors.lastname: Weiss
authors.forename: Gary
authors.initials: G
authors.lastname: Ginsberg
authors.forename: Yossef
authors.initials: Y
authors.lastname: Ezra