Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica Em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, CEP 21040-360, Brazil.
Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
Reprod Health. 2021 May 8;18(1):93. doi: 10.1186/s12978-021-01147-2.
In 2015, a quality improvement project of childbirth care called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce caesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital-the model following the recommendations of the PPA and the standard of care model-in reducing the proportion of caesarean sections.
We conducted a cost-effectiveness analysis using data from one of the private hospitals included in the PPA project. The main outcome was the proportion of caesarean section. We used total cost of hospitalization for women and newborns, from the health care sector perspective, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of caesarean section and of maternal and neonatal complications.
238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the caesarean section probability (88.6% vs 31.7%, p < 0.001) with an incremental cost-effectiveness ratio of US$1,237.40 per avoided caesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal near miss. The cost of uncomplicated vaginal births and caesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care.
The PPA model of care was cost-effective in reducing caesarean sections in women assisted in a Brazilian private hospital. Moreover, it reduced the frequency of early term births and did not increase the occurrence of severe negative maternal and neonatal outcomes.
2015 年，巴西公立和私立医院实施了一项名为“适当分娩项目”（Projeto Parto Adequado-PPA）的分娩护理质量改进项目，旨在提高分娩护理质量，并减少无临床指征的剖宫产。本研究的目的是对巴西一家私立医院现有的两种护理模式进行经济分析，以降低剖宫产率，这两种模式是遵循 PPA 建议的模式和标准护理模式。
我们使用参与 PPA 项目的一家私立医院的数据进行成本效益分析。主要结果是剖宫产率。我们使用从卫生保健部门角度来看，观察住院期间产妇和新生儿住院总费用。由于时间短，我们没有应用贴现率和通胀率调整。我们使用观察到的住院费用的最小值和最大值以及剖宫产和母婴并发症概率的变化进行单变量敏感性分析。
本分析纳入了 238 例产妇。PPA 护理模式使剖宫产概率降低了 56.9 个百分点（88.6%比 31.7%，p<0.001），避免每例剖宫产的增量成本效益比为 1237.40 美元。PPA 护理模式下的女性自然分娩和诱导分娩的比例更高，早产的比例更低。没有产妇、胎儿或新生儿死亡，也没有母婴接近死亡的病例有显著差异。阴道分娩和剖宫产的无并发症费用是影响 PPA 护理模式成本效益比的最重要参数。
在巴西一家私立医院，PPA 护理模式在降低剖宫产率方面具有成本效益，而且降低了早产的发生率，没有增加严重母婴不良结局的发生。
