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An Overview of the Health Economic Implications of Elective Caesarean Section

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  • Stavros Petrou
  • Kamran Khan

Abstract

The caesarean section rate has continued to increase in most industrialised countries, which raises a number of economic concerns. This review provides an overview of the health economic implications of elective caesarean section. It provides a succinct summary of the health consequences associated with elective caesarean section for both the infant and the mother over the perinatal period and beyond. It highlights factors that complicate our understanding of the health consequences of elective caesarean section, including inconsistencies in definitions and coding of the procedure, failure to adopt an intention-to-treat principle when drawing comparisons, and the widespread reliance on observational data. The paper then summarises the economic costs associated with elective caesarean section. Evidence is presented to suggest that planned caesarean section may be less costly than planned vaginal birth in some clinical contexts, for example where the singleton fetus lies in a breech position at term. In contrast, elective caesarean section (or caesarean section as a whole) appears to be more costly than vaginal delivery (either spontaneous or instrumented) in low-risk or unselected populations. The paper proceeds with an overview of economic evaluations associated with elective caesarean section. All are currently based on decision-analytic models. Evidence is presented to suggest that planned trial of labour (attempted vaginal birth) following a previous caesarean section appears to be a more cost-effective option than elective caesarean section, although its cost effectiveness is dependent upon the probability of successful vaginal delivery. There is conflicting evidence on the cost effectiveness of maternal request caesareans when compared with trial of labour. The paucity of evidence on the value pregnant women, clinicians and other groups in society place on the option of elective caesarean section is highlighted. Techniques that might be used to elicit preferences for elective caesarean section and its attributes are outlined. The review concludes with directions for future research in this area. Copyright Springer International Publishing Switzerland 2013

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  • Stavros Petrou & Kamran Khan, 2013. "An Overview of the Health Economic Implications of Elective Caesarean Section," Applied Health Economics and Health Policy, Springer, vol. 11(6), pages 561-576, December.
    • Handle: RePEc:spr:aphecp:v:11:y:2013:i:6:p:561-576
    DOI: 10.1007/s40258-013-0063-8
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    References listed on IDEAS

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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
    2. Christopher G Fawsitt & Jane Bourke & Richard A Greene & Claire M Everard & Aileen Murphy & Jennifer E Lutomski, 2013. "At What Price? A Cost-Effectiveness Analysis Comparing Trial of Labour after Previous Caesarean versus Elective Repeat Caesarean Delivery," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.
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    Cited by:

    1. Shen, Menghan & Li, Linyan, 2020. "Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?," Economics & Human Biology, Elsevier, vol. 36(C).
    2. Ion Petre & Flavia Barna & Cosmin Cîtu & Florin Gorun & Oana-Maria Gorun & Laurentiu Cezar Tomescu & Adrian Apostol & Anca Bordianu & Cristian Furau & Izabella Petre, 2023. "Development of a Framework for On-Demand Caesarean Section in Romania," IJERPH, MDPI, vol. 20(3), pages 1-8, February.
    3. Saad Zbiri & Patrick Rozenberg & Carine Milcent, 2024. "Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans," Post-Print hal-04626835, HAL.

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