Document Detail

The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial.
MedLine Citation:
PMID:  16606959     Owner:  NLM     Status:  MEDLINE    
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.
INTERPRETATION: 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.
Roberto Palencia; Amiram Gafni; Mary E Hannah; Susan Ross; Andrew R Willan; Sheila Hewson; Darren McKay; Walter Hannah; Hilary Whyte; Kofi Amankwah; Mary Cheng; Patricia Guselle; Michael Helewa; Ellen D Hodnett; Eileen K Hutton; Rose Kung; Saroj Saigal;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  174     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-11     Completed Date:  2006-04-25     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1109-13     Citation Subset:  AIM; IM    
Maternal, Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health, University of Toronto, Toronto, Ont.
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MeSH Terms
Breech Presentation*
Cesarean Section / adverse effects,  economics*
Delivery, Obstetric / adverse effects,  economics*
Health Care Costs / statistics & numerical data*
Health Services / utilization
Length of Stay
Pregnancy Outcome*
Comment In:
CMAJ. 2006 Nov 7;175(10):1243-6; author reply 1246   [PMID:  17098955 ]
CMAJ. 2006 Apr 11;174(8):1118-9   [PMID:  16606960 ]
Erratum In:
CMAJ. 2006 Jul 4;175(1):64

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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