Entringer Aline Piovezan, Pinto Márcia, Gomes Maria Auxiliadora de Souza Mendes
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Fundação Oswaldo Cruz. Neonatologia. Rio de Janeiro, RJ, Brasil.
Maternidade Escola da Universidade Federal do Rio de Janeiro. Unidade de Terapia Intensiva Neonatal. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2018 Nov 23;52:91. doi: 10.11606/S1518-8787.2018052000373.
To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women.
The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators' pricing tables, and pricing reference publications of health resources.
Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population.
It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.
对正常风险孕妇的自然分娩和选择性剖宫产进行成本效益分析。
本研究从补充健康的角度进行，补充健康是一个为私人产科护理提供资金的健康子系统，在巴西由健康计划运营商代表。参考人群为正常风险孕妇，她们可以选择自然分娩或选择性剖宫产，再细分为初产妇和有子宫瘢痕史的经产妇。构建了一个决策分析模型，包括从入院分娩到产妇出院的分娩方式选择以及对母亲和新生儿的健康后果。从科学文献中确定有效性指标，并通过咨询健康专业人员、健康计划运营商的定价表以及健康资源定价参考出版物获得成本数据。
对于初产正常风险孕妇，自然分娩相对于选择性剖宫产具有优势，成本更低（5210.96雷亚尔对5753.54雷亚尔），并且在所有评估结果方面有效性更好或相当。对于有子宫瘢痕史的经产妇，剖宫产成本（5364.07雷亚尔）低于自然分娩（5632.24雷亚尔），且有效性更好或相当；因此，剖宫产对该人群更有效。
有必要控制和审核无临床指征的剖宫产，尤其是初产妇的剖宫产，这有助于围产期护理的管理。
