Department of Anesthesiology and Critical Care Medicine Hadassah-Hebrew, University Medical Center, Ein Kerem, Jerusalem 91120, Israel.
Isr J Health Policy Res. 2014 Feb 24;3(1):5. doi: 10.1186/2045-4015-3-5.
External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery.
In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS.
Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs.
The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate.
外倒转术（ECV）的实施频率较低，98%的臀位胎儿需要通过手术分娩。椎管内镇痛可显著提高 ECV 的成功率，从而降低臀位分娩的剖宫产率。本研究旨在确定 ECV 椎管内麻醉给医院带来的额外成本是否能通过降低剖宫产率而节省的成本来抵消。
在我们的三级医院中，计算了 ECV、ECV 加麻醉剂量的脊髓阻滞、阴道分娩和剖宫产的三个变量，即人力、耗材和固定成本。比较了可能的分娩途径的总手术费用。人力数据来自管理层薪资，固定成本通过计算成本/使用寿命费率得出，耗材在 2008 年进行微观成本核算，以 2013 年新谢克尔表示。
剖宫产的费用最高，为 11670.54 新谢克尔，脊髓阻滞下成功 ECV 后阴道分娩的费用为 5497.2 新谢克尔。单独 ECV 的费用为 960.21 新谢克尔，ECV 加脊髓麻醉的费用为 1386.97 新谢克尔。阴道分娩、剖宫产和 ECV 的最高单项成本项目是人力。剖宫产昂贵的固定成本包括手术室托盘和产后住院（至少 3 天）。由于预计剖宫产率降低及其相关成本降低，脊髓阻滞下 ECV 更便宜。
ECV 手术成功率提高带来的额外成本被降低的剖宫产率所抵消。
