Washington, DC, USA - Approximately 300,000 women per year in the US with a prior cesarean delivery are planning the delivery of their second child and are therefore faced with the choice of whether to attempt a trial of labor (TOL). In order to adequately counsel these women, both the short-term and long-term maternal and infant outcome effects must be considered.
Researchers from The George Washington University Biostatistics Center in Washington, DC and the
Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health in Bethesda, MD appear to be the first to incorporate the long-term effects of multiple cesarean deliveries to estimate the cost-effectiveness of a TOL compared with an elective repeat cesarean delivery (ERCD). The long-term effects of placenta accreta, placenta previa as well as the outcomes of cerebral palsy and stress urinary incontinence were incorporated in a life-cycle model.
The cost-effectiveness analysis determined that TOL saved $164.2 million and gained 500 quality-adjusted life-years (QALYs) per 100,000 women. However, sensitivity analysis found that the conclusions were sensitive to several variables, namely the probability of successful TOL among women with no prior vaginal delivery, the probability of uterine rupture and the frequency of stress urinary incontinence (SUI).
Sharon A Gilbert, MBA, PhD, from George Washington University and lead author of the study states "To the best of our knowledge, our study is the first model comparing TOL with ERCD that incorporated the long-term consequences of cost-effectiveness analysis including; both maternal and infant outcomes, costs, and QALYs. Our study indicated that with the current state of science, TOL is the most cost-effective strategy, but also indicated the need for future research on topics where the model was sensitive, especially in the area of SUI."
The full study, "
The Lifetime Cost-Effectiveness of Trial of Labor After Cesarean in the United States" is published in
Value in Health.
Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research as well as policy papers to help health care leaders make evidence-based decisions. The journal is published bi-monthly and has over 8,000 subscribers (clinicians, decision-makers, and researchers worldwide).
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