Bost Brent W
Department of Economics and Finance, Lamar University, Beauville, Texas 77702, USA.
Am J Obstet Gynecol. 2003 Jun;188(6):1418-21; discussion 1421-3. doi: 10.1067/mob.2003.455.
The purpose of this study was to estimate the cost differences between elective cesarean delivery and the alternative of attempted vaginal delivery and to assess the economic impact of cesarean delivery on demand.
Cost data were obtained over a 12-month period from a not-for-profit community hospital to calculate a per-patient cost for clinical alternatives.
The average cost of an attempted vaginal delivery without oxytocin (Pitocin) or epidural anesthesia was 15.1% lower in nulliparous women and 20% lower in multiparous women than with elective cesarean delivery. However, in nulliparous women, the addition of Pitocin nullified any cost differences; if epidural anesthesia was also used, total costs exceeded the cost of elective cesarean delivery by almost 10%. The cost of a failed attempt at vaginal delivery was much higher than elective cesarean delivery for both groups. The average cost for all women who attempted vaginal delivery was only 0.2% less than the per-patient cost of elective cesarean delivery.
The adoption of a policy of cesarean delivery on demand should have little impact on the overall cost of obstetric care.
本研究旨在估算择期剖宫产与尝试阴道分娩两种方式之间的成本差异，并评估剖宫产对需求的经济影响。
从一家非营利性社区医院获取了为期12个月的成本数据，以计算每种临床分娩方式的人均成本。
未使用缩宫素（催产素）或硬膜外麻醉的情况下，初产妇尝试阴道分娩的平均成本比择期剖宫产低15.1%，经产妇低20%。然而，对于初产妇，使用缩宫素会消除成本差异；若同时使用硬膜外麻醉，总成本会比择期剖宫产高出近10%。两组中，尝试阴道分娩失败的成本均远高于择期剖宫产。所有尝试阴道分娩的女性的平均成本仅比择期剖宫产的人均成本低0.2%。
按需剖宫产政策的采用对产科护理的总体成本影响不大。
