ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2024 Mar 27

DOI: 10.23736/S2724-606X.24.05443-5

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

A vaginal birth is a cost-reduction strategy for women with a low-lying placenta

Elisabetta COLCIAGO ^{1, 2} ✉, Pietro FERRARA ^{3, 4}, Isadora VAGLIO TESSITORE ¹, Lorenzo G. MANTOVANI ^{3, 4}, Patrizia VERGANI ¹, Sara ORNAGHI ^{1, 2}

¹ School of Medicine and Surgery, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy; ² Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy; ³ Department of Medicine and Surgery, Center for Public Health Research, University of Milano-Bicocca, Monza, Monza-Brianza, Italy; ⁴ Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, Italy

BACKGROUND: Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a low-lying placenta (LLP) is still controversial. Since no previous data are available on the topic, the aim of this study was to evaluate the HCRU and economic impact on the Italian HC system of vaginal birth (VB) and CD in women with a LLP.
METHODS: This retrospective study used patient-level real-world data of a cohort of women with a LLP confirmed at 28-30 weeks. A cost-minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the actual use of hospital resources, a micro-costing analysis (MCA) was performed to more comprehensively evaluate the economic impact of VB and CD.
RESULTS: The study included 86 women with a LLP at the third trimester scan, of which 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the resources needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD.
CONCLUSIONS: The use of patient-level real-world data allowed to generate basic information to assess the value of available interventions in case of LLP. A VB should be promoted in women with LLP, avoiding further burden on the HC system’s limited resources.

KEY WORDS: Placenta; Cesarean section; Health care rationing; Parturition