Abstract
Purpose
To undertake an economic analysis of repeat Caesarean births in low-risk women (LRW)
not in labour in Ontario who delivered at 37–38 weeks (<39 weeks) vs. 39–40 weeks
(≥39 weeks) gestation.
Methods
Data from the Better Outcomes Registry & Network (BORN) Information System for fiscal
years 2012–2013 and 2013–2014 meeting the definition for elective repeat CS (ERCS)
for LRW between 37 and 40 weeks gestation. Costs were obtained from the Ottawa Hospital
Data Warehouse and applied through to discharge.
Results
For April 2012 to March 2013, we extracted 3637 ERCS dyads at <39 weeks and 3282 dyads
at ≥39 weeks. There were 334 NICU admissions at <39 weeks (0.92%) and 235 at ≥39 weeks
(0.72%). Average neonate cost was $1247.99 (<39 weeks) vs. $1200.77 (≥39 weeks)—a
difference of $47.22. Average dyad cost was $3608.92 (<39 weeks) vs. $3577.04 (≥39
weeks)—a difference of $31.88 per birth. If these births were delayed to ≥39 weeks,
net savings of $173 864 and $115 947 annually would be realized on “baby only” and
“dyad” costs, respectively. For April 2013 to March 2014, we extracted 2875 ERCS dyads
at ≤39 weeks and 3892 dyads at ≥39 weeks. There were 216 NICU admissions ≤39 weeks
(0.75%) and 224 at ≥39 weeks (0.58%). Average neonate cost was $1268.56 (<39 weeks)
vs. $1126.56 (≥39 weeks)—a difference of $142.00 per birth. Average dyad cost was
$3605.70 (≤39 weeks) vs. $3456.61 (≥39 weeks)—a difference of $149.08. If these births
were delayed to ≥39 weeks, net annual savings of $404 842 and $428 605 would be realized
on “baby only” and “dyad” costs respectively.
Conclusions
Restricting repeat CS in LRW to ≥39 weeks is a cost-effective strategy.
Résumé
Objectif
Effectuer une analyse économique des naissances par césariennes itératives en Ontario
chez des femmes exposées à de faibles risques qui n'étaient pas en travail et qui
ont donné naissance après 37 à 38 semaines (<39 semaines) de gestation ou après 39
à 40 semaines (≥39 semaines) de gestation.
Méthodologie
Les données ont été extraites du système d'information du Registre et réseau des bons
résultats dès la naissance (BORN) pour les années fiscales 2012-2013 et 2013-2014.
Les recherches visaient les césariennes itératives planifiées (CIP) entre 37 et 40
semaines de gestation chez des femmes exposées à de faibles risques. Les coûts des
soins jusqu'au congé de l'hôpital ont été obtenus de l'Institut de recherche en santé
d'Ottawa.
Résultats
Pour la période d'avril 2012 à mars 2013, nous avons extrait les données relatives
à 3637 dyades à <39 semaines et à 3282 dyades à ≥39 semaines. Il y a eu 334 admissions
à l'UNSI à <39 semaines (0,92 %) et 235 admissions à ≥39 semaines (0,72 %). Le coût
moyen par nouveau-né était de 1 247,99 $ (<39 semaines) comparativement à 1 200,77
$ (≥39 semaines), soit une différence de 47,22 $. Le coût moyen par dyade était de
3 608,92 $ (<39 semaines) comparativement à 3 577,04 $ (≥39 semaines), soit une différence
de 31,88 $ par naissance. Si ces naissances avaient été reportées à ≥39 semaines,
on aurait pu réaliser des économies annuelles nettes de 173 864 $ (nouveau-nés) et
de 115 947 $ (dyades). Pour la période d'avril 2013 à mars 2014, nous avons extrait
les données relatives à 2875 dyades à <39 semaines et à 3892 dyades à ≥39 semaines.
Il y a eu 216 admissions à l'UNSI à <39 semaines (0,75 %) et 224 admissions à ≥39
semaines (0,58 %). Le coût moyen par nouveau-né était de 1 268,56 $ (<39 semaines)
comparativement à 1 126,56 $ (≥39 semaines), soit une différence de 142,00 $ par naissance.
Le coût moyen par dyade était de 3 605,70 $ (<39 semaines) comparativement à 3 456,61
$ (≥39 semaines), soit une différence de 149,08 $. Si ces naissances avaient été reportées
à ≥39 semaines, on aurait pu réaliser des économies annuelles nettes de 404 842 $
(nouveau-nés) et de 428 605 $ (dyades).
Conclusions
Restreindre la pratique de césariennes itératives à ≥39 semaines chez les femmes exposées
à de faibles risques est une stratégie efficace du point de vue des coûts.
Key Words
Abbrevations:
BORN (better outcomes registry & network), ERCS (elective repeat CS), LOS (length of stay)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 22, 2018
Accepted:
April 11,
2018
Received:
January 11,
2018
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
