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Elective Repeat Caesarean Section in Low-Risk Women—Economic Evaluation Comparing Births Before vs. After 39 Weeks Gestation in Ontario, Canada

  • Christopher J. Longo
    Correspondence
    Corresponding Author: Dr. Christopher J. Longo, DeGroote School of Business, McMaster University, Burlington, ON.
    Affiliations
    DeGroote School of Business, Member Centre for Health Economics and Policy Analysis, McMaster University, Burlington, ON

    Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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  • JoAnn Harrold
    Affiliations
    Faculty of Medicine, University of Ottawa, Ottawa, ON

    Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON

    The Ottawa Hospital Research Institute, Ottawa, ON

    Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON

    Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON
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  • Sandra Dunn
    Affiliations
    Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON

    Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON

    School of Nursing, University of Ottawa, Ottawa, ON
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  • Graeme Smith
    Affiliations
    Department of Obstetrics & Gynecology, Faculty of Health Sciences, Queen's University, Kingston, ON
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Published:October 22, 2018DOI:https://doi.org/10.1016/j.jogc.2018.04.010

      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)
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