Health economic analysis of a cluster‐randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section

Objective To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design Economic analysis alongside the cluster‐randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women‐centred care). Setting Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population Pregnant women with a history of one previous lower‐segment caesarean section; sites were randomised (3:2) to intervention or control. Methods A cost–utility analysis from both societal and health‐services perspectives, using a decision tree. Main outcome measures Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results The mean difference in costs per quality‐adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258–268) and 0.008 QALYs (95% CI 0.008–0.009 QALYs) for Germany, €456 (95% CI €448–464) and 0.052 QALYs (95% CI 0.051–0.053 QALYs) for Ireland, and €1174 (95% CI €1170–1178) and 0.006 QALYs (95% CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost‐effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion The OptiBIRTH intervention was likely to be cost‐effective in Ireland and Germany. Tweetable The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost‐effective in Germany and Ireland. Tweetable The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost‐effective in Germany and Ireland.