RENO, NEV. — From a societal perspective, the most cost-effective course of action for impending preterm delivery at 24 weeks' gestation is an unwillingness on the part of the physician to perform cesarean section, Gianni Cazan-London, M.D., and colleagues reported in a poster presented at the annual meeting of the Society for Maternal-Fetal Medicine.
The researchers, from the University of Michigan Health System in Ann Arbor, conducted a cost-benefit analysis comparing aggressive management (willingness to perform cesarean section) with nonaggressive management (unwillingness to perform cesarean section).
If the overall goal is simply to produce a surviving infant, the choice of management has only a minimal effect on overall costs, with aggressive management costing $38,434 more than nonaggressive management.
On the other hand, if the goal is to produce a surviving infant who is healthy, aggressive management costs $690,969 more per healthy survivor than does nonaggressive management.
While aggressive management does slightly improve the chances of producing a healthy survivor, it also doubles the probability of producing an infant with major and costly morbidity, according to the analysis.
The investigators based their analysis on a comprehensive literature search, which yielded estimates of the probabilities and costs for various options on a decision-tree model.
Costs included neonatal hospitalization, burial for death, and lifetime interventions and/or special education for infants with major disabilities. The investigators expressed the results in 2004 U.S. dollars.
According to the analysis, unwillingness to perform cesarean section would cost $675,425 per survivor (overall) and $1,688,562 per healthy survivor.
In contrast, willingness to perform cesarean section would cost $713,859 per survivor (overall) and $2,379,531 per healthy survivor.
The investigators noted that emotional and financial costs to parents, health care providers, and society at large are substantial, regardless of the physician's management strategy. They concluded that physicians should strive to provide objective information to the parents whose child is likely to be born with extremely low birth weight. The parents, then, should be allowed to make the ultimate decisions on the aggressiveness of obstetric management.