Re: VBAC
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Apr 19 20:57:28 2005
I would caution you that it is almost impossible to determine "Cost".
Most all of these studies are looking at "Charges" and ca;lling them
costs.
On 4/19/05, D. Ashley Hill <dahmd@cfl.rr.com> wrote:
> I thought cesareans would be more costly than attempted vaginal
> delivery, until I spoke with our hospital finance department, and read
> an interesting article in AJOG (see below). I was told that a policy of
> "100% c/section" would be advantageous for hospitals. Apparently it
> would allow accurate staffing (less nursing on call time, for example)
> and better bed management. Further, rather than 2 days undergoing
> induction, then a cesarean, followed by 3 days of in-hospital recovery,
> the 100% section policy would make things more efficient. According to
> an interesting paper in AJOG (see cut and paste from Medline below),
> there is no significant cost differences between attempted vaginal
> delivery and elective cesarean. However, elective cesarean is 10% less
> costly than attempted vaginal deliveries when oxytocin and epidural are
> used. In our area almost everyone gets oxytocin and an epidural,
> therefore it appears that elective cesareans (at least the first one)
> may be equally or less costly than when patients undergo labor.
>
> Ashley
>
> Am J Obstet Gynecol. 2003 Jun;188(6):1418-21.
>
> Cesarean delivery on demand: what will it cost?
> Bost BW.
>
> OBJECTIVE: The purpose of this study was to estimate the cost
> differences between elective cesarean delivery and the alternative of
> attempted vaginal delivery and to assess the economic impact of cesarean
> delivery on demand. STUDY DESIGN: Cost data were obtained over a
> 12-month period from a not-for-profit community hospital to calculate a
> per-patient cost for clinical alternatives. RESULTS: The average cost
> of an attempted vaginal delivery without oxytocin (Pitocin) or epidural
> anesthesia was 15.1% lower in nulliparous women and 20% lower in
> multiparous women than with elective cesarean delivery. However, in
> nulliparous women, the addition of Pitocin nullified any cost
> differences; if epidural anesthesia was also used, total costs exceeded
> the cost of elective cesarean delivery by almost 10%. The cost of a
> failed attempt at vaginal delivery was much higher than elective
> cesarean delivery for both groups. The average cost for all women who
> attempted vaginal delivery was only 0.2% less than the per-patient cost
> of elective cesarean delivery. CONCLUSION: The adoption of a policy of
> cesarean delivery on demand should have little impact on the overall
> cost of obstetric care.
>
> --
> D. Ashley Hill, MD
> Associate Director
> Department of Obstetrics and Gynecology
> Florida Hospital Family Practice Residency
> and Loch Haven Ob/Gyn Group
> Orlando, Florida
>
--
R. Daniel Braun
Kinky for Governor
