Planned cesarean delivery compared to induction of labor in women with class III obesity: a cost-minimization analysis*. (1st October 2016)

• Record Type: Journal Article
• Authors: Subramaniam, Akila; Corvey, Kathryn J.; Kilgore, Meredith L.; Edwards, Rodney K.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 29:Number 19(2016)
• Page Start: 3084
• Page End: 3088
• Publication Date: 2016-10-01
• Subjects: Class III obesity -- costs -- induction of labor -- planned cesarean delivery; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2015.1119113
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective : To compare the costs between planned cesarean delivery (CD) and induction of labor (IOL) in women with class III obesity. Methods : We conducted a cost-minimization analysis using data from a previous study of women with a BMI ≥40 kg/m 2 delivering term singletons via planned CD or after IOL. Decision trees were built with branches for two "treatments": planned CD and IOL (probabilities derived from parent study). Direct and total costs were obtained for each mother–infant pair. Sensitivity analyses for probability of successful IOL were performed. Results : A total of 661 mother–infant pairs were included – 399 IOLs and 262 planned CDs. Of 399 IOLs, 236 (59%) delivered vaginally and 163 (41%) had a CD. IOL was slightly less costly. For IOL and planned CD, respectively, direct costs were $7416 versus $7474, and total costs were $11 545 versus $11 665. Sensitivity analyses indicated that IOL was the least costly strategy if the probability of vaginal delivery after IOL was >57% (0.575 for direct costs; 0.570 for total costs). There was, however, a slight cost advantage to planned CD in women with a prior cesarean. Conclusions : In women with class III obesity, IOL is less costly than planned CD if the probability of vaginal delivery after IOL in an individual patient is greater than 57%.