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Title: A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis.
Authors: Johri, Mira
Ng, Edmond S W
Bermudez-Tamayo, Clara
Hoch, Jeffrey S
Ducruet, Thierry
Chaillet, Nils
Keywords: Adolescent;Adult;Caesarean section/utilization;Cost-benefit analysis;Female;Guideline adherence;Infant;Medical audit;Multilevel analysis;Newborn;Pregnancy outcomes;Randomized controlled trial
metadata.dc.subject.mesh: Cesarean Section
Commission on Professional and Hospital Activities
Cost-Benefit Analysis
Health Care Costs
Infant, Newborn
Pregnancy Outcome
Prospective Studies
Risk Assessment
Issue Date: 22-May-2017
Abstract: Widespread 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. A 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. The 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  From 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. International Clinical Trials Registry Platform, ISRCTN95086407 . Registered on 23 October 2007.
metadata.dc.identifier.doi: 10.1186/s12916-017-0859-8
Appears in Collections:Producción 2020

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