Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.

Tracy, SK; Tracy, MB

Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.

Tracy, SK Tracy, MB

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Publication Type:: Journal Article
Citation:: BJOG, 2003, 110 (8), pp. 717 - 724
Issue Date:: 2003-08

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Field	Value	Language
dc.contributor.author	Tracy, SK	en_US
dc.contributor.author	Tracy, MB	en_US
dc.date.issued	2003-08	en_US
dc.identifier.citation	BJOG, 2003, 110 (8), pp. 717 - 724	en_US
dc.identifier.issn	1470-0328	en_US
dc.identifier.uri	http://hdl.handle.net/10453/4460
dc.description.abstract	OBJECTIVE: To estimate the cost of "the cascade" of obstetric interventions introduced during labour for low risk women. DESIGN: A cost formula derived from population data. SETTING: New South Wales, Australia. POPULATION: All 171,157 women having a live baby during 1996 and 1997. METHODS: Four groups of interventions that occur during labour were identified. A cost model was constructed using the known age-adjusted rates for low risk women having one of three birth outcomes following these pre-specified interventions. Costs were based on statewide averages for the cost of labour and birth in hospital. MAIN OUTCOME MEASURES: The outcome measure is an "average cost unit per woman" for low risk women, predicted by the level of intervention during labour. Obstetric care is classified as either private obstetric care in a private or public hospital, or routine public hospital care. RESULTS: The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. CONCLUSIONS: The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women.	en_US
dc.language	eng	en_US
dc.relation	http://purl.org/au-research/grants/arc/C79920018
dc.relation.ispartof	BJOG	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pregnancy Outcome	en_US
dc.subject.mesh	Prenatal Care	en_US
dc.subject.mesh	Analgesia, Epidural	en_US
dc.subject.mesh	Analgesia, Obstetrical	en_US
dc.subject.mesh	Episiotomy	en_US
dc.subject.mesh	Labor, Induced	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Labor, Obstetric	en_US
dc.subject.mesh	Private Sector	en_US
dc.subject.mesh	Public Sector	en_US
dc.subject.mesh	Costs and Cost Analysis	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.title	Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	110	en_US
utslib.location.activity	England	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	110	en_US

Abstract:

OBJECTIVE: To estimate the cost of "the cascade" of obstetric interventions introduced during labour for low risk women. DESIGN: A cost formula derived from population data. SETTING: New South Wales, Australia. POPULATION: All 171,157 women having a live baby during 1996 and 1997. METHODS: Four groups of interventions that occur during labour were identified. A cost model was constructed using the known age-adjusted rates for low risk women having one of three birth outcomes following these pre-specified interventions. Costs were based on statewide averages for the cost of labour and birth in hospital. MAIN OUTCOME MEASURES: The outcome measure is an "average cost unit per woman" for low risk women, predicted by the level of intervention during labour. Obstetric care is classified as either private obstetric care in a private or public hospital, or routine public hospital care. RESULTS: The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. CONCLUSIONS: The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women.

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http://hdl.handle.net/10453/4460