Managing uncomplicated singleton breech pregnancy using 'OptiBreech collaborative care' pathway: early economic model and value of information analysis.
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Abstract
Objective: Management of breech presentation is a subject of ongoing clinical debate. The cost-effectiveness of improving safe vaginal breech birth is unknown. This study examines potential cost-effectiveness of 'OptiBreech collaborative care' and assesses value of undertaking further research.
Methods: A decision tree was used to evaluate the potential cost-effectiveness of 'OptiBreech care' versus standard care for a hypothetical cohort of women with confirmed singleton breech pregnancy after 36+0 weeks gestation and babies born thereafter for one year. Probabilities, costs, and outcomes were obtained from literature and 'OptiBreech' pilot trial. Uncertainty and value of information were analysed to prioritise future research. The main outcomes were incremental cost-utility (ICUR) and cost-effectiveness ratios (ICER), net benefits, cost-effectiveness acceptability curve, and expected value of perfect and perfect partial information.
Results: Using pre-existing evidence, 'OptiBreech care' is less effective but sufficiently less costly i.e. cost-effective compared with standard care. Influential parameters include cephalic birth rate after external cephalic version, training costs and vaginal birth rate after opting for vaginal birth. Emerging evidence for 'OptiBreech care' significantly improved the cost-effectiveness ratio. The expected population value of perfect information (EVPI) was £31.5 million, with utilities identified as key research priority.
Conclusions: Planned vaginal birth for singleton breech pregnancy may be cost-effective despite a potential loss in health outcomes. Emerging data on the effectiveness of 'OptiBreech care' significantly increased the cost-effectiveness likelihood. Conclusions did not change for litigation cost assumptions or for sole neonatal perspective. Further research on health utilities would provide a valuable reduction in decision uncertainty.
期刊介绍：
Value in Health contains original research articles for pharmacoeconomics, health economics, and outcomes research (clinical, economic, and patient-reported outcomes/preference-based research), as well as conceptual and health policy articles that provide valuable information for health care decision-makers as well as the research community. As the official journal of ISPOR, Value in Health provides a forum for researchers, as well as health care decision-makers to translate outcomes research into health care decisions.
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