Abstract
The purpose of this study was to conduct a cost-effectiveness analysis of spontaneous vaginal delivery and elective cesarean (with no clinical indication) for normal risk pregnant women, from the perspective of the Brazilian Unified National Health System. An analytical decision model was developed and included the choice of delivery mode and clinical consequences for mothers and newborns, from admission for delivery to hospital discharge. The reference population consisted of normal risk pregnant women with singleton, at-term gestations in cephalic position, subdivided into primiparas and multiparas with prior uterine scar. Cost data were obtained from three public maternity hospitals (two in Rio de Janeiro, one in Belo Horizonte, Minas Gerais State, Brazil). Direct costs were identified with human resources, hospital inputs, and capital and administrative costs. Effectiveness measures were identified, based on the scientific literature. The study showed that vaginal delivery was more efficient for primiparas, at lower cost (BRL 1,709.58; USD 518.05) than cesarean (BRL 2,245.86; USD 680.56) and greater effectiveness for three of the four target outcomes. For multiparas with prior uterine scar, repeat cesarean was cost-effective for the outcomes averted maternal morbidity, averted uterine rupture, averted neonatal ICU, and averted neonatal death, but the result was not supported by probabilistic sensitivity analysis. For maternal death as the outcome, there was no difference in effectiveness, and labor showed the lowest cost. This study can contribute to the management of perinatal care, expanding measures that encourage adequate delivery according to the population's characteristics.
Highlights
O parto vaginal também apresentou maior probabilidade de ser custo-efetivo na análise de sensibilidade probabilística, considerando-se os intervalos de limiar testados
Na análise de sensibilidade probabilística, a curva de aceitabilidade mostrou que apenas para dois desfechos a cesariana poderia ser mais custo-efetiva do que o parto vaginal
Summary
O objetivo deste estudo foi realizar uma análise de custo-efetividade do parto vaginal espontâneo comparado à cesariana eletiva, sem indicação clínica, para gestantes de risco habitual, sob a perspectiva do Sistema Único de Saúde. O objetivo deste trabalho é realizar uma análise de custo-efetividade do parto vaginal espontâneo comparado à cesariana eletiva, sem indicação clínica, sob a perspectiva do SUS. Foi realizada uma análise de custo-efetividade do parto vaginal espontâneo e da cesariana eletiva, sem indicação clínica na perspectiva do SUS provedor, responsável pela prestação de serviços de saúde. Além do custo com os procedimentos parto vaginal e cesariana eletiva, foi calculado o custo da assistência ao recém-nascido em sala de parto; permanência em alojamento conjunto para mãe, recém-nascido e acompanhante; intercorrências maternas clínicas Tabela 1 Variáveis do modelo de decisão para primíparas, multíparas e recém-nascido
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