Abstract
BackgroundExternal cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery.MethodsIn our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS.ResultsCesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs.ConclusionsThe additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate.
Highlights
External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically
The current study aims to determine whether the additional cost to the hospital of spinal anesthesia is offset by increased success rates for the ECV procedure; through decreased cesarean delivery rates
We manually searched the bibliography of relevant manuscripts. Using this search strategy we identified 6 randomized controlled trial publications using neuraxial blockade for ECV and 3 cost analyses, and used these data to calculate our probability of ECV success with spinal anesthesia and delivery outcomes [7,8,9,15,16,17,18,19,20]
Summary
External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Cesarean delivery is recommended by national guidelines for the breech presenting fetus (3-4% of pregnancies) [1,2] These same national guidelines recommend the availability of an external cephalic version (ECV) service; potentially enabling attempted vaginal delivery. Potential reasons for poor uptake of ECV include low ECV success rates, lack of Immediate hospital and health fund costs of cesarean delivery are higher than vaginal delivery [7,8]. Addition of neuraxial blockade for ECV generates a hospital cost benefit if the ECV success rate is increased 11% above a baseline of 38% without neuraxial blockade [9]. The study showing these data combined anesthetic (increased ECV success rate) and analgesic (little effect on ECV success) doses in their analysis; potentially muting the findings
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