Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section.

Abstract

To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Fifteen maternity units in three European countries - Germany (five), Ireland (five), and Italy (five) - with relatively low VBAC rates. Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. A cost-utility analysis from both societal and health-services perspectives, using a decision tree. Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost-utility ratios were calculated per country. The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95%CI €258-268) and 0.008QALYs (95%CI 0.008-0.009QALYs) for Germany, €456 (95%CI €448-464) and 0.052QALYs (95%CI 0.051-0.053QALYs) for Ireland, and €1174 (95%CI €1170-1178) and 0.006QALYs (95%CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.