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首页> 外文期刊>BJOG: an international journal of obstetrics and gynaecology >Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section
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Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section

机译：核心随机试验（光学率）的健康经济分析，旨在提高剖腹产后阴道分娩率

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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: euro263 (95% CI euro258-268) and 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, euro456 (95% CI euro448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and euro1174 (95% CI euro1170-1178) and 0.006 QALYs (95% CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were euro33,741/QALY for Germany, euro8785/QALY for Ireland, and euro214,318/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.
机译：目的旨在对典型的干预措施进行健康经济分析，旨在提高阴道分娩率，与常规护理相比。通过增强的女性为中心护理，设计经济分析与群组随机的光学三次试验（通过增加剖腹产（VBAC）后的阴道分娩优化分娩）。在三个欧洲国家设定十五个产妇单位 - 德国（五），爱尔兰（五）和意大利（五） - VBAC率相对较低。人口孕妇有一个以前的下段剖腹产的历史;遗址随机（3：2）进行干预或控制。方法使用决策树，来自社会和健康服务的角度的成本实用性分析。在妊娠识别到3个月之前，在妊娠识别到3个月之间比较了每名妇女和婴幼儿的主要结果和婴幼儿的资源使用。基于剖宫产率，母亲和新生儿病症和死亡率，每个国家计算增量成本实用比率。结果采用概率敏感性分析，从疗程和对照组的社会角度获得的每个质量调整的生命年龄（QALYS）的平均差异为：EURO263（95％CI EURO258-268）和0.008QALYS（95德国欧元456欧元（95％CI EURO448-464）和0.052 QALYS（95％CI 0.051-0.053 QALYS）的％CI 0.008-0.009 QALYS）和欧元1174（95％CI EURO1170-1178）和0.006QALYS（95％） CI 0.005-0.007 QALYS）为意大利。增量成本实用比率为德国欧元33,741欧元，欧元8785欧元，爱尔兰QALY，以及意大利的欧元214,318欧元/ QALY，德国成本效益为51％，爱尔兰92％，以及15欧元意大利的％。结论光学间干预可能在爱尔兰和德国具有成本效益。

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