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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Health economic analysis of a cluster‐randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section
Authors: Fobelets, Maaike
Beeckman, Katrien
Healy, Patricia
Grylka, Susanne
Nicoletti, Jane
Devane, Declan
Gross, Mechthild Maria
Morano, Sandra
Daly, Deirdre
Begley, Cecily
Putman, Koen
DOI: 10.21256/zhaw-3265
Published in: BJOG - International Journal of Obstetrics and Gynaecology
Issue Date: 2019
Publisher / Ed. Institution: Wiley
ISSN: 1470-0328
Language: English
Subjects: Cost-effectiveness analysis; Elective repeat caesarean; Quality of life; Vaginal birth after caesarean
Subject (DDC): 362.1041: Health economics
618.4: Childbirth
Abstract: Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries - Germany (five), Ireland (five), and Italy (five) - with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost-utility analysis from both societal and health-services perspectives, using a decision tree. Main Outcome Measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost-utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258-268) and 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, €456 (95% CI €448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and €1174 (95% CI €1170-1178) and 0.006 QALYs (95% CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany.
Further description: Der Artikel wurde innerhalb des EU-Projekts OptiBIRTH erstellt.
This is the peer reviewed version of the following article: [Haunberger, S, Rüegger, C, Baumgartner, E. Experiences with a psychosocial screening instrument (S‐FIRST) to identify the psychosocial support needs of parents of children suffering from cancer. Psycho‐Oncology. 2019; 28: 1025‐ 1032.], which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Fulltext version: Accepted version
License (according to publishing contract): Licence according to publishing contract
Restricted until: 2020-05-01
Departement: School of Health Sciences
Organisational Unit: Institute of Midwifery (IHB)
Appears in collections:Publikationen Gesundheit

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