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Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section

Journal article
Authors M. Fobelets
K. Beeckman
P. Healy
S. Grylka-Baeschlin
J. Nicoletti
D. Devane
M. M. Gross
S. Morano
D. Daly
Cecily Begley
K. Putman
Published in BJOG: An International Journal of Obstetrics and Gynaecology
Volume 126
Issue 8
Pages 1043-1051
ISSN 1470-0328
Publication year 2019
Published at Institute of Health and Care Sciences
Pages 1043-1051
Language en
Keywords Cost-effectiveness analysis, elective repeat caesarean, quality of life, vaginal birth after caesarean, adult, article, childbirth, controlled study, cost effectiveness analysis, cost utility analysis, decision tree, female, Germany, human, human experiment, infant, Ireland, Italy, mortality, newborn morbidity, outcome assessment, pregnancy, pregnant woman, probability, quality adjusted life year, randomized controlled trial, sensitivity analysis, vaginal birth after cesarean
Subject categories Obstetrics, Gynecology and Reproductive Medicine, Health Care Service and Management, Health Policy and Services and Health Economy


Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services perspectives, using a decision tree. Main outcome measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258–268) and 0.008 QALYs (95% CI 0.008–0.009 QALYs) for Germany, €456 (95% CI €448–464) and 0.052 QALYs (95% CI 0.051–0.053 QALYs) for Ireland, and €1174 (95% CI €1170–1178) and 0.006 QALYs (95% CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. © 2019 Royal College of Obstetricians and Gynaecologists

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