Cost-effectiveness analysis of spontaneous vaginal delivery versus elective caesarean section for maternal outcomes in Colombia

Objective: To analyze the cost-effectiveness of elective cesarean section compared to spontaneous vaginal delivery in short-term maternal outcomes for low-risk obstetrical population in Colombia. Study Design: A cost-effectiveness study using a health care system perspective was performed during 2019 for Colombia. The reference population were women with a low-risk pregnancy delivered at term, either by a spontaneous vaginal delivery or elective cesarean section under medical or non-medical indications. An analytical decision model was designed for maternal outcomes. The time horizon was 42 days postpartum, and the health effects were measured by Quality Adjusted Life Years (QALYs). A review of the literature and a validation process by a national expert committee were conducted to estimate the maternal outcomes and their probabilities. Costs were estimated with a top-down analysis. An incremental cost-effectiveness ratio was calculated, and a sensitivity analysis was performed. Results: Within a 42 days' time horizon, it was found that spontaneous vaginal delivery is the less expensive and more effective delivery alternative, it showed a reduction in costs (301 USD) and a gain in QALYs (0.02). Then, our analysis suggests that spontaneous vaginal delivery is the dominant alternative compared to elective cesarean section. Conclusions: For Colombia, spontaneous vaginal delivery showed to be the cost-effective delivery alternative. These results are useful not only for obstetricians, but for decision makers, who should encourage nationwide health policies in favor of spontaneous vaginal delivery.

• Autores: Ayala Alonso, Nathalia
• Fecha de publicación: 2021
• Institución: Universidad de los Andes
• Repositorio: Séneca: repositorio Uniandes
• Idioma: spa
• OAI Identifier: oai:repositorio.uniandes.edu.co:1992/53400
• Acceso en línea: http://hdl.handle.net/1992/53400
• Palabra clave: Cesárea (Operación); Parto; Análisis de costos; Medicina
• Rights: openAccess
• License: Attribution-NonCommercial-NoDerivatives 4.0 Internacional