Economic Evaluation of the DiAMOND Randomized Trial: Cost and Outcomes of 2 Decision Aids for Mode of Delivery among Women with a Previous Cesarean Section

Abstract

Background. Maternal preferences should be considered in decisions about mode of delivery following a previous cesarean, but risks and benefits are unclear. Decision aids can help decision making, although few studies have assessed costs in conjunction with effectiveness. Objective. Economic evaluation of 2 decision aids for women with 1 previous cesarean. Design. Cost-consequences analysis. Materials and Methods. Data sources were self-reported resource use and outcome and published national unit costs. The target population was women with 1 previous cesarean. The time horizon was 37 weeks’ gestation and 6 weeks postnatal. The perspective was health care delivery system. The interventions were usual care, usual care plus an information program, and usual care plus a decision analysis program. The outcome measures were costs to the National Health Service (NHS) in the United Kingdom (UK), score on the Decisional Conflict Scale, and mode of delivery. Results of Main Analysis. Cost of delivery represented 84% of the total cost; mode of delivery was the most important determinant of cost differences across the groups. Mean (SD) total cost per mother and baby: 2033 (677) for usual care, 2069 (738) for information program, and 2019 (741) for decision analysis program. Decision aids reduced decisional conflict. Women using the decision analysis program had fewest cesarean deliveries. Results of Sensitivity Analysis. Applying a cost premium to emergency cesareans over electives had little effect on group comparisons. Conclusions were unaffected. Limitations. Disparity in timing of outcomes and costs, data completeness, and quality. Conclusions. Decision aids can reduce decisional conflict in women with a previous cesarean section when deciding on mode of delivery. The information program could be implemented at no extra cost to the NHS. The decision analysis program might reduce the rate of cesarean sections without any increase in costs