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Presentation

Session: Alternate Care
Room: Chydenius Rooms
Time: Thu 16:00-17:15

Presenter: Elena Pizzo (Imperial College London. Business School)

Abstract

The recent large increase in caesarean sections (CSs) in Europe seems not to be completely justified: CS is practiced independently of epidemiological reasons (physician’s induction or mother’s demand).
In Italy the introduction of epidural analgesia among the Essential Levels of Assistance (LEA) has been proposed with the hope that this will help to counteract the rise of CSs.
This work aims at analyzing the costs and benefits effectively involved in alternative methods of delivery- vaginal delivery (VD), with and without epidural analgesia, and planned caesarean.
The empirical analysis has been conducted in an Italian university hospital, through direct collection of data, administration of questionnaires and direct interviews to patients and health staff.
A logistic regression has been used to model the probability of the event “delivery with planned caesarean section” occurring as a function of a set of clinical and socio-economic characteristics of the women. The results confirm the hypothesis that caesarean section is widely performed for non-medical reasons (Osborn and Signorelli, 1995; Frost, 2005).
A micro-costing analysis has been used to evaluate the direct health costs of each delivery method, following an activity-based costing approach.
The analysis shows that caesarean section is, on average, more expensive if compared to vaginal delivery, but the difference is marginal if we take into account the opportunity-cost of time during labour. Since caesarean section is generally reimbursed more than vaginal delivery to cover the supposed higher costs of surgical intervention, differences between the real costs and the DRG tariffs may induce opportunistic behaviour in terms of clinical practice.
From a societal perspective we consider also the indirect costs, the intangible costs (transport, medications, artificial feeding, time lost) and the benefits of each method.
Patient’s wellbeing is measured through appropriate anonymous instruments that consider the changes in clinical and psychological dimensions due to the delivery experience. The instruments used are: the State-Trait Anxiety Inventory (STAI Y-form) and the Italian Questionnaire of Pain (QUID) before delivery, the STAI and the Childbirth Perception Questionnaire (CPQ) two days after delivery.
The cost-effectiveness analysis shows that, in general, vaginal delivery with analgesia provides better results both in terms of costs and, but the final effect of its introduction is not clear: it may reduce the frequency of inappropriate caesarean sections, but also it may increase the costs due to complications.

Key Terms

cost-effectiveness, caserean section, vaginal delivery, epidural analgesia, STAI, CPQ

Authors:

Elena Pizzo (Imperial College London. Business School)

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