RT Journal Article
T1 A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis
A1 Johri, Mira
A1 Ng, Edmond S W
A1 Bermudez-Tamayo, Clara
A1 Hoch, Jeffrey S
A1 Ducruet, Thierry
A1 Chaillet, Nils
K1 Randomized controlled trial
K1 Cost-benefit analysis
K1 Caesarean section/utilization
K1 Pregnancy outcomes
K1 Medical audit
K1 Guideline adherence
K1 Multilevel analysis
K1 Female
K1 Adult
K1 Adolescent
K1 Infant
K1 Newborn
K1 Ensayo clínico controlado aleatorio
K1 Análisis costo-beneficio
K1 Cesárea
K1 Resultado del embarazo
K1 Auditoría médica
K1 Adhesión a directriz
K1 Análisis multinivel
K1 Femenino
K1 Adulto
K1 Adolescente
K1 Lactante
K1 Recién nacido
AB BackgroundWidespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions.MethodsA prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3 months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clinical subgroups of high-risk versus low-risk pregnancies and estimated the joint uncertainty in cost-effectiveness over 20,000 trial simulations. We decomposed costs to identify drivers of change.ResultsThe intervention group experienced per-patient reductions of 0.005 CS (95% confidence interval (CI): −0.015 to 0.004, P = 0.09) and $180 (95% CI: −$277 to − $83, P < 0.001). Women with low-risk pregnancies experienced statistically significant reductions in CS rates and costs; changes for the high-risk subgroup were not significant. The intervention was “dominant” (effective in reducing CS and less costly than usual care) in 86.08% of simulations. It reduced costs in 99.99% of simulations. Cost reductions were driven by lower rates of neonatal complications in the intervention group (−$190, 95% CI: −$255 to − $125, P < 0.001). Given 88,000 annual provincial births, a similar intervention could save $15.8 million (range: $7.3 to $24.4 million) in Quebec annually.ConclusionsFrom a healthcare payer perspective, a multifaceted intervention involving audits and feedback resulted in a small reduction in caesarean deliveries and important cost savings. Cost reductions are consistent with improved quality of care in intervention group hospitals.
PB BioMed Central
YR 2017
FD 2017-05-22
LK http://hdl.handle.net/10668/2890
UL http://hdl.handle.net/10668/2890
LA en
NO Johri M, Ng ESW, Bermúdez-Tamayo C, Hoch JS, Ducruet T, Chaillet N. A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis. BMC Med. 2017 May;15:96
DS RISalud
RD Apr 19, 2025