I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussels, Belgium.
Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
BMC Pregnancy Childbirth. 2018 Apr 11;18(1):92. doi: 10.1186/s12884-018-1720-6.
The OptiBIRTH study incorporates a multicentre cluster randomised trial in 15 hospital sites across three European countries. The trial was designed to test a complex intervention aimed at improving vaginal birth after caesarean section (VBAC) rates through increasing women's involvement in their care. Prior to developing a robust standardised model to conduct the health economic analysis, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in four European countries.
A decision-analytic model was developed to estimate the costs and the health effects, measured using Quality Adjusted Life Years (QALYs), of VBAC compared with ERCD. A cost-effectiveness analysis for the period from confirmation of pregnancy to 6 weeks postpartum was performed for short-term consequences and during lifetime for long-term consequences, based on a hypothetical cohort of 100,000 pregnant women in each of four different countries; Belgium, Germany, Ireland and Italy. A societal perspective was adopted. Where possible, transition probabilities, costs and health effects were adapted from national data obtained from the respective countries. Country-specific thresholds were used to determine the cost-effectiveness of VBAC compared to ERCD. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions.
Within a 6-week time horizon, VBAC resulted in a reduction in costs, ranging from €3,334,052 (Germany) to €66,162,379 (Ireland), and gains in QALYs ranging from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country. Compared to ERCD, VBAC is the dominant strategy in all four countries. Applying a lifetime horizon, VBAC is dominant compared to ERCD in all countries except for Germany (probabilistic analysis, ICER: €8609/QALY). In conclusion, compared to ERCD, VBAC remains cost-effective when using a lifetime time.
In all four countries, VBAC was cost-effective compared to ERCD for low-risk women. This is important for health service managers, economists and policy makers concerned with maximising health benefits within limited and constrained resources.
OptiBIRTH 研究纳入了三个欧洲国家 15 个医院地点的多中心集群随机试验。该试验旨在通过增加女性对其护理的参与度，来测试一种旨在提高剖宫产后阴道分娩（VBAC）率的复杂干预措施。在开发稳健的标准化模型进行健康经济分析之前，对一个假设队列进行了分析，以估计 VBAC 与择期再次剖宫产（ERCD）相比，在四个欧洲国家低风险妇女中的成本和健康效果。
开发了一个决策分析模型，以估计 VBAC 与 ERCD 相比的成本和健康效果，使用健康调整生命年（QALYs）进行衡量。对 100,000 名孕妇的假设队列进行了短期后果的成本效益分析，从确认怀孕到产后 6 周，并进行了长期后果的成本效益分析，基于每个国家的假设队列；比利时、德国、爱尔兰和意大利。采用了社会视角。在可能的情况下，根据各自国家获得的国家数据，调整了转移概率、成本和健康效果。使用特定于国家的阈值来确定 VBAC 与 ERCD 相比的成本效益。进行了确定性和概率敏感性分析，以检查模型假设的不确定性。
在 6 周的时间范围内，VBAC 降低了成本，从德国的€3334052 到爱尔兰的€66162379，每个国家每 100000 名分娩妇女获得的 QALY 增加了 6399（意大利）至 7561（德国）。与 ERCD 相比，VBAC 在所有四个国家都是主导策略。在整个生命周期中，VBAC 在除德国以外的所有国家均优于 ERCD（概率分析，ICER：每 QALY €8609）。总之，与 ERCD 相比，在整个生命周期中，VBAC 仍然具有成本效益。
在所有四个国家，VBAC 对低风险妇女来说都是一种比 ERCD 更具成本效益的选择。这对关注在有限和受限资源内最大化健康效益的卫生服务管理者、经济学家和政策制定者来说很重要。
