An Overview of the Health Economic Implications of Elective Caesarean Section
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The caesarean section rate has continued to increase in most industrialised countries, which raises a number of economic concerns. This review provides an overview of the health economic implications of elective caesarean section. It provides a succinct summary of the health consequences associated with elective caesarean section for both the infant and the mother over the perinatal period and beyond. It highlights factors that complicate our understanding of the health consequences of elective caesarean section, including inconsistencies in definitions and coding of the procedure, failure to adopt an intention-to-treat principle when drawing comparisons, and the widespread reliance on observational data. The paper then summarises the economic costs associated with elective caesarean section. Evidence is presented to suggest that planned caesarean section may be less costly than planned vaginal birth in some clinical contexts, for example where the singleton fetus lies in a breech position at term. In contrast, elective caesarean section (or caesarean section as a whole) appears to be more costly than vaginal delivery (either spontaneous or instrumented) in low-risk or unselected populations. The paper proceeds with an overview of economic evaluations associated with elective caesarean section. All are currently based on decision-analytic models. Evidence is presented to suggest that planned trial of labour (attempted vaginal birth) following a previous caesarean section appears to be a more cost-effective option than elective caesarean section, although its cost effectiveness is dependent upon the probability of successful vaginal delivery. There is conflicting evidence on the cost effectiveness of maternal request caesareans when compared with trial of labour. The paucity of evidence on the value pregnant women, clinicians and other groups in society place on the option of elective caesarean section is highlighted. Techniques that might be used to elicit preferences for elective caesarean section and its attributes are outlined. The review concludes with directions for future research in this area.
KeywordsCaesarean Section Vaginal Delivery Caesarean Delivery Discrete Choice Experiment Elective Caesarean Section
The Warwick Clinical Trials Unit benefited from facilities funded through the Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands. The funding bodies had no influence on the writing of this paper or the decision to submit the paper for publication. The views contained in the paper are those of the authors and not necessarily of the funding bodies.
Conflicts of interest
Stavros Petrou and Kamran Khan have no conflicts of interest to declare that are directly relevant to the content of this review.
Stavros Petrou designed this review article, synthesised and interpreted the relevant information, and wrote the article. Kamran Khan conducted the literature reviews and extracted relevant data from selected studies. Stavros Petrou acts as the guarantor for the overall content.
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