Vaginal Birth after Cesarean Section vs Elective Repeat Cesarean Section: A Cost-consequence Analysis

Arunasalam Pathmeswaran, Chanil D Ekanayake, Rasika Herath, Prasantha Wijesinghe, Swetha Thangasamy, Sanjeewa Padumadasa, Sunil Fernando, Tiran Dias
2021 Journal of SAFOG with DVD  
Aim: There is limited evidence on the cost-effectiveness of vaginal birth after cesarean section vs elective repeat cesarean section. The aim of this study was to compare the outcomes and costs of vaginal birth after cesarean section vs elective repeat cesarean section. Materials and methods: A cost-consequence study was done from April 1, 2018 to March 31, 2019. Women admitted for delivery with one previous cesarean section were selected. Exclusion criteria were: multiple gestations, placenta
more » ... stations, placenta previa, morbidly adherent placenta, birth weight <2.5 kg or >4 kg, and patients undergoing emergency cesarean section for antepartum emergencies. The outcomes and costs of vaginal birth after cesarean section vs elective repeat cesarean section were compared. Results: The vaginal birth after cesarean section was successful in 34 (50.7%) cases. There was no difference in median postpartum hospital stay between vaginal birth after cesarean section (n = 67)[2 (1-3) days] and elective repeat cesarean section (n = 158) [2 (2-2.25) days] (p = 0.15). There was no significant difference in total costs between vaginal birth after cesarean section and elective repeat cesarean section vs USD 470 (452-494), p = 0.78]. The direct cost of the vaginal birth after cesarean section successful group (n = 34) was USD 427 (361-462) vs failed vaginal birth after cesarean section group (n = 32) USD 505 (476-716) (p <0.001). There was a significant difference in postpartum hospital stay between successful vaginal birth after cesarean section [2 (1-3) days], failed vaginal birth after cesarean section [2 (2-3.75) days], and elective repeat cesarean section [2 (2-2.25) days] (p < 0.01). Conclusion: The absence of a significant difference in postpartum hospital stay and cost between vaginal birth after cesarean section and elective repeat cesarean section raises serious clinical concerns with possible implications for health policy stakeholders.
doi:10.5005/jp-journals-10006-1849 fatcat:2j35auuetbhclonnr5jljdzj44