ECONOMIC EVALUATIONS COMPARING A TRIAL OF LABOR WITH AN ELECTIVE REPEAT CESAREAN DELIVERY: A SYSTEMATIC REVIEW
| Main Authors: | Anna Joy Rogers, MA, Nathaniel G. Rogers, MD, Meredith L. Kilgore, RN, MSPH, PhD, Akila Subramaniam, MD, MPH, Lorie M. Harper, MD, MSCI |
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| Format: | Book |
| Bahasa: | eng |
| Terbitan: |
Elsevier
, 2017
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| Subjects: | |
| Online Access: |
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Daftar Isi:
- For women who have had a previous low transversecesarean delivery, the decision to undergo a trial of labor aftercesarean (TOLAC) or an elective repeat cesarean delivery (ERCD) hasimportant clinical and economic ramifications. Objectives: To evaluate the cost-effectiveness of the alternative choices of a TOLAC andan ERCD for women with low-risk, singleton gestation pregnancies.Methods: We searched EMBASE, MEDLINE, CINAHL, Cochrane Library,EconLit, and the Cost-Effectiveness Analysis Registry with no language, publication, or date restrictions up until October 2015. Studieswere included if they were primary research, compared a TOLAC withan ERCD, and provided information on the relative cost of thealternatives. Abstracts and partial economic evaluations wereexcluded. Results: Of 310 studies initially reviewed, 7 studies wereincluded in the systematic review. In the base-case analyses, 4 studiesconcluded that TOLAC was dominant over ERCD, 1 study found ERCDto be dominant, and 2 studies found that although TOLAC was morecostly, it offered more benefits and was thus cost-effective from apopulation perspective when considering societal willingness to payfor better outcomes. In sensitivity analyses, cost-effectiveness wasfound to be dependent on a high likelihood of TOLAC success, low riskof uterine rupture, and low relative cost of TOLAC comparedwith ERCD. Conclusions: For women who are likely to have asuccessful vaginal delivery, routine ERCD may result in excessmorbidity and cost from a population perspective.
- STIKes Muhammadiyah Palembang