title: Neuraxial blockade for external cephalic version: Cost analysis.
abstract: OBJECTIVE
  Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates.
  
  
  METHODS
  A decision-analysis model was developed using costs and probabilities occurring prenatally through the delivery hospital admission. Model inputs were derived from the literature, national databases, and local supply costs. Univariate and bivariate sensitivity analyses and Monte Carlo simulations were performed to assess model robustness.
  
  
  RESULTS
  Neuraxial blockade was cost saving to both hospitals ($30 per delivery) and insurers ($539 per delivery) using baseline estimates. From both perspectives, however, the model was sensitive to multiple variables. Monte Carlo simulation indicated neuraxial blockade to be more costly in approximately 50% of scenarios. The model demonstrated that routine use of neuraxial blockade during external cephalic version, compared to no neuraxial blockade, prevented 17 cesarean deliveries for every 100 external cephalic versions attempted.
  
  
  CONCLUSIONS
  Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Yamasato
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Bliss
authors.initials: B
authors.lastname: Kaneshiro
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Salcedo
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000191:economics; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000191:economics; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000191:economics; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000191:economics; D001946:Breech Presentation / Q000191:economics / Q000601:surgery*; D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics; D017046:Cost Savings; D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical; D003663:Decision Trees; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D009407:Nerve Block / Q000009:adverse effects* / Q000191:economics; D011247:Pregnancy; D014481:United States; D014710:Version, Fetal / Q000009:adverse effects* / Q000191:economics
keywords: breech; cesarean delivery; cost; external cephalic version; neuraxial blockade