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

M Fobelets; K Beeckman; P Healy; S Grylka-Baeschlin; J Nicoletti; D Devane; M M Gross; S Morano; D Daly; C Begley; K Putman

doi:10.1111/1471-0528.15673

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

M Fobelets, K Beeckman, P Healy, S Grylka-Baeschlin, J Nicoletti, D Devane, M M Gross, S Morano, D Daly, C Begley, K Putman

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	1043-1051
Number of pages	9
Journal	BJOG : An International Journal of Obstetrics & Gynaecology
Volume	126
Issue number	8
DOIs	https://doi.org/10.1111/1471-0528.15673
Publication status	Published - Jul 2019

Bibliographical note

Keywords

Adult
Cluster Analysis
Cost-Benefit Analysis
Female
Germany
Humans
Ireland
Italy
Maternal-Child Health Services/economics
Patient Acceptance of Health Care/statistics & numerical data
Pregnancy
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic/economics
Vaginal Birth after Cesarean/economics

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10.1111/1471-0528.15673

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Fobelets, M., Beeckman, K., Healy, P., Grylka-Baeschlin, S., Nicoletti, J., Devane, D., Gross, M. M., Morano, S., Daly, D., Begley, C., & Putman, K. (2019). Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section. BJOG : An International Journal of Obstetrics & Gynaecology, 126(8), 1043-1051. https://doi.org/10.1111/1471-0528.15673

Fobelets, M ; Beeckman, K ; Healy, P ; Grylka-Baeschlin, S ; Nicoletti, J ; Devane, D ; Gross, M M ; Morano, S ; Daly, D ; Begley, C ; Putman, K. / Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section. In: BJOG : An International Journal of Obstetrics & Gynaecology. 2019 ; Vol. 126, No. 8. pp. 1043-1051.

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

abstract = "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.",

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author = "M Fobelets and K Beeckman and P Healy and S Grylka-Baeschlin and J Nicoletti and D Devane and Gross, {M M} and S Morano and D Daly and C Begley and K Putman",

note = "{\textcopyright} 2019 Royal College of Obstetricians and Gynaecologists.",

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language = "English",

volume = "126",

pages = "1043--1051",

journal = "British Journal of Obstetrics and Gynaecology",

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number = "8",

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Fobelets, M , Beeckman, K, Healy, P, Grylka-Baeschlin, S, Nicoletti, J, Devane, D, Gross, MM, Morano, S, Daly, D, Begley, C & Putman, K 2019, 'Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section', BJOG : An International Journal of Obstetrics & Gynaecology, vol. 126, no. 8, pp. 1043-1051. https://doi.org/10.1111/1471-0528.15673

Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section. / Fobelets, M ; Beeckman, K; Healy, P; Grylka-Baeschlin, S; Nicoletti, J; Devane, D; Gross, M M; Morano, S; Daly, D; Begley, C; Putman, K.

In: BJOG : An International Journal of Obstetrics & Gynaecology, Vol. 126, No. 8, 07.2019, p. 1043-1051.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section

AU - Fobelets, M

AU - Beeckman, K

AU - Healy, P

AU - Grylka-Baeschlin, S

AU - Nicoletti, J

AU - Devane, D

AU - Gross, M M

AU - Morano, S

AU - Daly, D

AU - Begley, C

AU - Putman, K

PY - 2019/7

Y1 - 2019/7

N2 - 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.

AB - 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.

KW - Adult

KW - Cluster Analysis

KW - Cost-Benefit Analysis

KW - Female

KW - Germany

KW - Humans

KW - Ireland

KW - Italy

KW - Maternal-Child Health Services/economics

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Pregnancy

KW - Quality-Adjusted Life Years

KW - Randomized Controlled Trials as Topic/economics

KW - Vaginal Birth after Cesarean/economics

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U2 - 10.1111/1471-0528.15673

DO - 10.1111/1471-0528.15673

M3 - Article

C2 - 30957402

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EP - 1051

JO - British Journal of Obstetrics and Gynaecology

JF - British Journal of Obstetrics and Gynaecology

SN - 1470-0328

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ER -

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

Abstract

Bibliographical note

Keywords

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