Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

Table 3 Costs for management pathways, derived from decision tree, Figure 1

Pathways for breech management	Management procedures (ECV with/without spinal, subsequent VD or CD)	Unit cost NIS	CD/VD rates after ECV[19],[20] Relative probability (95% CI)	Relative cost NIS (CD rate 16% after successful ECV)
Pathway A
No ECV	CD	11670.54	100%
			Total pathway A	11670.54
Pathway B
B1	ECV (failure), CD	12630.75	55.2% (0.40-0.64)	6972.17
B2	ECV (success), CD	12630.75	7.2% (0.03-0.16)	909.41
B3	ECV (success), VD	5070.44	37.6% (0.26-0.49)	1906.49
			Total pathway B	9988.07
Pathway
C1	ECV + spinal, CD	13057.51	23.9% (0.15-0.35)	3120.74
C2	ECV + spinal, CD	13057.51	12.2% (0.06-0.21)	1593.02
C3	ECV + spinal, VD	5497.2	63.9% (0.52-0.75)	3512.71
			Total pathway C	8226.47

Key: Costs are derived from Table 1 unit costs and% of each pathway occurring.
CD = cesarean delivery, VD = vaginal delivery, ECV = external cephalic version, CI = confidence interval.
Pathway A = no ECV, Pathway B = ECV without spinal anesthesia, Pathway C = ECV with spinal anesthesia.
For CI calculation, the denominator is 67 (Table 3) [19, 20].

ISSN: 2045-4015