Is vaginal birth after caesarean cost-effective compared to an elective caesarean section in Belgium?

Background The rising rate of caesarean sections is a global issue despite international calls to avoid unnecessary caesareans. In Flanders (Belgium), the caesarean section rate rose above 20% since 2013. However, studies have shown that vaginal birth after caesarean (VBAC) is a viable option for low-risk women and associated with various benefits compared to an elective repeat caesarean delivery (ERCD). The rising frequency of caesarean sections entails important economic implications, which should gain attention from health policy makers. Therefore, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in Belgium.
Methods A health economic model was developed, based on a decision tree to estimate the costs and health effects of VBAC versus ERCD for a hypothetical cohort of 100,000 low-risk pregnant women. The time horizon was from confirmation of pregnancy to 6 weeks postpartum. Where possible, transition probabilities, costs and health effects were adapted from national data. The threshold of cost-effectiveness €36,000/QALY, based on the Belgian GDP. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions. A societal perspective was adopted.
Results VBAC was a dominant strategy compared to ERCD and resulted in a reduction in costs of €17,743,050, 7265 gains in QALYs and a reduction of 32497 caesarean sections per 100,000 birthing women. The incremental cost-effectiveness ratio (ICER) was €-2,496 per QALY gained.
Conclusions This economic model clearly showed that VBAC is associated with costs savings and gains in QALYs compared to ERCD for low-risk women. Health progammes that facilitate VBAC in these women should be considered and are relevant alternatives for health service managers and policy makers concerned with maximising health benefits within limited and constrained resources.