Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort

Sharon A. Gilbert, William A. Grobman, Mark B. Landon, Catherine Y. Spong, Dwight J. Rouse, Kenneth J. Leveno, Michael W. Varner, Ronald J. Wapner, Yoram Sorokin, Mary J. O'Sullivan, Baha M. Sibai, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective To estimate the cost-effectiveness of a trial of labor after one previous cesarean delivery (TOLAC). Study Design A model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Probabilistic estimates were obtained from women matched on their baseline characteristics using propensity scores. Cost data, quality-adjusted life-years (QALYs), and data on cerebral palsy were incorporated from the literature. Results The TOLAC strategy dominated the ERCD strategy at baseline, with $138.6 million saved and 1703 QALYs gained per 100,000 women. The model was sensitive to five variables: the probability of uterine rupture, the probability of successful TOLAC, the QALY of failed TOLAC, the cost of ERCD, and the cost of successful TOLAC without complications. When the probability of TOLAC success was at the base value, 68.5%, TOLAC was preferred if the probability of uterine rupture was 4.2% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 42.6% or more. Conclusion A TOLAC is less expensive and more effective than an ERCD in a group of women with balanced baseline characteristics.

Original languageEnglish (US)
Pages (from-to)11-20
Number of pages10
JournalAmerican Journal of Perinatology
Volume30
Issue number1
DOIs
StatePublished - 2013

Fingerprint

Trial of Labor
Cost-Benefit Analysis
Uterine Rupture
Quality-Adjusted Life Years
Costs and Cost Analysis
Propensity Score
Cerebral Palsy

Keywords

  • cost-effectiveness
  • elective repeat cesarean
  • propensity scores
  • trial of labor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Gilbert, S. A., Grobman, W. A., Landon, M. B., Spong, C. Y., Rouse, D. J., Leveno, K. J., ... Mercer, B. M. (2013). Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort. American Journal of Perinatology, 30(1), 11-20. https://doi.org/10.1055/s-0032-1333206

Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort. / Gilbert, Sharon A.; Grobman, William A.; Landon, Mark B.; Spong, Catherine Y.; Rouse, Dwight J.; Leveno, Kenneth J.; Varner, Michael W.; Wapner, Ronald J.; Sorokin, Yoram; O'Sullivan, Mary J.; Sibai, Baha M.; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

In: American Journal of Perinatology, Vol. 30, No. 1, 2013, p. 11-20.

Research output: Contribution to journalArticle

Gilbert, SA, Grobman, WA, Landon, MB, Spong, CY, Rouse, DJ, Leveno, KJ, Varner, MW, Wapner, RJ, Sorokin, Y, O'Sullivan, MJ, Sibai, BM, Thorp, JM, Ramin, SM & Mercer, BM 2013, 'Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort', American Journal of Perinatology, vol. 30, no. 1, pp. 11-20. https://doi.org/10.1055/s-0032-1333206
Gilbert, Sharon A. ; Grobman, William A. ; Landon, Mark B. ; Spong, Catherine Y. ; Rouse, Dwight J. ; Leveno, Kenneth J. ; Varner, Michael W. ; Wapner, Ronald J. ; Sorokin, Yoram ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. / Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort. In: American Journal of Perinatology. 2013 ; Vol. 30, No. 1. pp. 11-20.
@article{f024cd56e35c498ba0c5ae58be1592ee,
title = "Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort",
abstract = "Objective To estimate the cost-effectiveness of a trial of labor after one previous cesarean delivery (TOLAC). Study Design A model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Probabilistic estimates were obtained from women matched on their baseline characteristics using propensity scores. Cost data, quality-adjusted life-years (QALYs), and data on cerebral palsy were incorporated from the literature. Results The TOLAC strategy dominated the ERCD strategy at baseline, with $138.6 million saved and 1703 QALYs gained per 100,000 women. The model was sensitive to five variables: the probability of uterine rupture, the probability of successful TOLAC, the QALY of failed TOLAC, the cost of ERCD, and the cost of successful TOLAC without complications. When the probability of TOLAC success was at the base value, 68.5{\%}, TOLAC was preferred if the probability of uterine rupture was 4.2{\%} or less. When the probability of uterine rupture was at the base value, 0.8{\%}, the TOLAC strategy was preferred as long as the probability of success was 42.6{\%} or more. Conclusion A TOLAC is less expensive and more effective than an ERCD in a group of women with balanced baseline characteristics.",
keywords = "cost-effectiveness, elective repeat cesarean, propensity scores, trial of labor",
author = "Gilbert, {Sharon A.} and Grobman, {William A.} and Landon, {Mark B.} and Spong, {Catherine Y.} and Rouse, {Dwight J.} and Leveno, {Kenneth J.} and Varner, {Michael W.} and Wapner, {Ronald J.} and Yoram Sorokin and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",
year = "2013",
doi = "10.1055/s-0032-1333206",
language = "English (US)",
volume = "30",
pages = "11--20",
journal = "American Journal of Perinatology",
issn = "0735-1631",
publisher = "Thieme Medical Publishers",
number = "1",

}

TY - JOUR

T1 - Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort

AU - Gilbert, Sharon A.

AU - Grobman, William A.

AU - Landon, Mark B.

AU - Spong, Catherine Y.

AU - Rouse, Dwight J.

AU - Leveno, Kenneth J.

AU - Varner, Michael W.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2013

Y1 - 2013

N2 - Objective To estimate the cost-effectiveness of a trial of labor after one previous cesarean delivery (TOLAC). Study Design A model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Probabilistic estimates were obtained from women matched on their baseline characteristics using propensity scores. Cost data, quality-adjusted life-years (QALYs), and data on cerebral palsy were incorporated from the literature. Results The TOLAC strategy dominated the ERCD strategy at baseline, with $138.6 million saved and 1703 QALYs gained per 100,000 women. The model was sensitive to five variables: the probability of uterine rupture, the probability of successful TOLAC, the QALY of failed TOLAC, the cost of ERCD, and the cost of successful TOLAC without complications. When the probability of TOLAC success was at the base value, 68.5%, TOLAC was preferred if the probability of uterine rupture was 4.2% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 42.6% or more. Conclusion A TOLAC is less expensive and more effective than an ERCD in a group of women with balanced baseline characteristics.

AB - Objective To estimate the cost-effectiveness of a trial of labor after one previous cesarean delivery (TOLAC). Study Design A model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Probabilistic estimates were obtained from women matched on their baseline characteristics using propensity scores. Cost data, quality-adjusted life-years (QALYs), and data on cerebral palsy were incorporated from the literature. Results The TOLAC strategy dominated the ERCD strategy at baseline, with $138.6 million saved and 1703 QALYs gained per 100,000 women. The model was sensitive to five variables: the probability of uterine rupture, the probability of successful TOLAC, the QALY of failed TOLAC, the cost of ERCD, and the cost of successful TOLAC without complications. When the probability of TOLAC success was at the base value, 68.5%, TOLAC was preferred if the probability of uterine rupture was 4.2% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 42.6% or more. Conclusion A TOLAC is less expensive and more effective than an ERCD in a group of women with balanced baseline characteristics.

KW - cost-effectiveness

KW - elective repeat cesarean

KW - propensity scores

KW - trial of labor

UR - http://www.scopus.com/inward/record.url?scp=84873567887&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873567887&partnerID=8YFLogxK

U2 - 10.1055/s-0032-1333206

DO - 10.1055/s-0032-1333206

M3 - Article

VL - 30

SP - 11

EP - 20

JO - American Journal of Perinatology

JF - American Journal of Perinatology

SN - 0735-1631

IS - 1

ER -