Clinical Trials Unit, Gibbet Hill Road, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK,
Appl Health Econ Health Policy. 2013 Dec;11(6):561-76. doi: 10.1007/s40258-013-0063-8.
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.
剖宫产率在大多数工业化国家持续上升，这引发了一些经济方面的担忧。本综述提供了选择性剖宫产的健康经济学影响概述。它简明扼要地总结了围产期和围产期后与选择性剖宫产相关的母婴健康后果。它强调了一些因素，这些因素使我们难以理解选择性剖宫产的健康后果，包括该手术的定义和编码不一致、在进行比较时未能采用意向治疗原则，以及广泛依赖观察性数据。然后，本文总结了与选择性剖宫产相关的经济成本。有证据表明，在某些临床情况下，计划性剖宫产可能比计划性阴道分娩成本更低，例如在足月时胎儿臀位的情况下。相比之下，在低风险或未选择的人群中，选择性剖宫产（或剖宫产总体而言）似乎比阴道分娩（无论是自然分娩还是器械分娩）成本更高。本文接着概述了与选择性剖宫产相关的经济评估。所有这些评估目前都基于决策分析模型。有证据表明，在先前剖宫产的基础上尝试计划性试产（阴道分娩）似乎是一种更具成本效益的选择，尽管其成本效益取决于阴道分娩成功的概率。与试产相比，关于产妇要求剖宫产的成本效益存在相互矛盾的证据。强调了缺乏关于孕妇、临床医生和社会其他群体对选择性剖宫产选择的价值的证据。概述了可能用于引出对选择性剖宫产及其属性的偏好的技术。本综述最后为该领域的未来研究指明了方向。
