BANFF, ALTA. — An attempted external cephalic version and subsequent delivery costs more than a planned cesarean section for a term breech pregnancy, but it is still cost effective, based on national success rates for the maneuver, Jonathan Tan said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.
“ECV [external cephalic version] is cost effective when compared to scheduled cesarean for breech delivery if the probability of ECV success is above 46%,” said Mr. Tan, a medical student at State University of New York at Stony Brook.
“The 58% national average for ECV success in the United States puts us right in the range of cost-effectiveness, but it is still important to note that ECV costs more than a planned cesarean delivery,” Mr. Tan said.
A scheduled cesarean delivery costs around $7,200 while an ECV costs about $1,200 with an additional cost of $5,000 for a vaginal delivery, he said. However, not all ECV attempts are successful, and not all successes result in a vaginal delivery; “there are other indications for cesarean section,” he said.
In his analysis using a computer-based decision model, Mr. Tan used rates from the literature for successful ECV, spontaneous reversion, and probability of unanticipated emergency cesarean to calculate an incremental cost-effectiveness ratio of $31,600 per quality-adjusted life year gained for conducting a trial of ECV.
Although the American College of Obstetricians and Gynecologists currently recommends that all women near term with breech presentations should be offered a trial of ECV (ACOG Practice Bulletin Number 13, 2000), “in many hospitals in the United States, cesarean section is the exclusive method of management,” he said.