PT  - JOURNAL ARTICLE
AU  - Roberto Palencia
AU  - Amiram Gafni
AU  - Mary E. Hannah
AU  - Susan Ross
AU  - Andrew R. Willan
AU  - Sheila Hewson
AU  - Darren McKay
AU  - Walter Hannah
AU  - Hilary Whyte
AU  - Kofi Amankwah
AU  - Mary Cheng
AU  - Patricia Guselle
AU  - Michael Helewa
AU  - Ellen D. Hodnett
AU  - Eileen K. Hutton
AU  - Rose Kung
AU  - Saroj Saigal
ED  - ,
TI  - The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial
AID  - 10.1503/cmaj.050796
DP  - 2006 Apr 11
TA  - Canadian Medical Association Journal
PG  - 1109--1113
VI  - 174
IP  - 8
4099  - http://www.cmaj.ca/content/174/8/1109.short
4100  - http://www.cmaj.ca/content/174/8/1109.full
SO  - CMAJ2006 Apr 11; 174
AB  - Background: The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery. Methods: We used a third-party–payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (≤ 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations. Results: The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth ($7165 v. $8042 per mother and infant; mean difference –$877, 95% credible interval –$1286 to –$473). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth ($7255 v. $8440) and women having had at least one prior birth ($7071 v. $7559). Although the treatment effect was largest in the subgroup of women having their first child, there was no statistically significant interaction between treatment and parity since the 95% credible intervals for difference in treatment effects between parity equalling zero and parity of one or greater all include zero. Interpretation: Planned cesarean section was found to be less costly than planned vaginal birth for the singleton fetus in a breech presentation at term in the Term Breech Trial.