Subramaniam Akila, Corvey Kathryn J, Kilgore Meredith L, Edwards Rodney K
a Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA and.
b Department of Health Care Organization and Policy , School of Public Health, University of Alabama at Birmingham , Birmingham , AL , USA.
J Matern Fetal Neonatal Med. 2016 Oct;29(19):3084-8. doi: 10.3109/14767058.2015.1119113. Epub 2015 Dec 15.
To compare the costs between planned cesarean delivery (CD) and induction of labor (IOL) in women with class III obesity.
We conducted a cost-minimization analysis using data from a previous study of women with a BMI ≥40 kg/m(2) delivering term singletons via planned CD or after IOL. Decision trees were built with branches for two "treatments": planned CD and IOL (probabilities derived from parent study). Direct and total costs were obtained for each mother-infant pair. Sensitivity analyses for probability of successful IOL were performed.
A total of 661 mother-infant pairs were included - 399 IOLs and 262 planned CDs. Of 399 IOLs, 236 (59%) delivered vaginally and 163 (41%) had a CD. IOL was slightly less costly. For IOL and planned CD, respectively, direct costs were $7416 versus $7474, and total costs were $11 545 versus $11 665. Sensitivity analyses indicated that IOL was the least costly strategy if the probability of vaginal delivery after IOL was >57% (0.575 for direct costs; 0.570 for total costs). There was, however, a slight cost advantage to planned CD in women with a prior cesarean.
In women with class III obesity, IOL is less costly than planned CD if the probability of vaginal delivery after IOL in an individual patient is greater than 57%.
比较Ⅲ级肥胖女性计划剖宫产（CD）和引产（IOL）的成本。
我们使用先前一项研究的数据进行了成本最小化分析，该研究对象为BMI≥40kg/m²且通过计划剖宫产或引产分娩足月单胎的女性。构建决策树，其分支为两种“治疗方法”：计划剖宫产和引产（概率源自母研究）。获取每对母婴的直接成本和总成本。对引产成功概率进行敏感性分析。
共纳入661对母婴——399例引产和262例计划剖宫产。在399例引产中，236例（59%）经阴道分娩，163例（41%）进行了剖宫产。引产的成本略低。引产和计划剖宫产的直接成本分别为7416美元和7474美元，总成本分别为11545美元和11665美元。敏感性分析表明，如果引产后阴道分娩的概率>57%（直接成本为0.575；总成本为0.570），引产是成本最低的策略。然而，有过剖宫产史的女性进行计划剖宫产有轻微的成本优势。
在Ⅲ级肥胖女性中，如果个体患者引产后阴道分娩的概率大于57%，引产的成本低于计划剖宫产。
