Economic analysis of mode of birth in women with low-lying placenta

Abstract

Abstract Introduction Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization, including multiple obstetric interventions and their related costs. While there is consensus that CD should be performed in case of placenta previa, the most appropriate mode of birth in women with low-lying placenta is still controversial, due to lack of robust data. The aim of this study was to evaluate the healthcare resource utilization and economic impact on the Italian healthcare system of vaginal birth (VB) and CD in women with a low-lying placenta, from a national healthcare service perspective. Method For this retrospective cohort study, patient-level real-world data were derived from a cohort of women with low-lying placenta confirmed at 28–32 weeks’ gestation during the third trimester scan. Low-lying placenta was diagnosed when the inferior placental edge was within 1 to 20 mm from the internal. A cost minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the real hospital resources used, a micro-costing analysis (MCA) was performed to provide a more comprehensive evaluation of the economic impact of modes of birth. Results The study included 86 women with low-lying placenta at the third trimester scan, 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the time needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD. Conclusion The use of patient-level real-world data made it possible to generate basic information to assess the value of available interventions in case of low-lying placenta. A VB should be promoted as a safe option to women with low-lying placenta, avoiding further burden on the healthcare system’s limited resources.