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Rosa Maria Soares Madeira Domingues
Fundacao Oswaldo Cruz
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5722-8127
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Background: In 2015, a quality improvement project of childbirth care called Adequate Birth Project (“Projeto Parto Adequado”- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce cesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital - the model following the recommendations of the PPA and the standard of care model - in reducing the proportion of cesarean sections.
Methods: We conducted a case study in one of the private hospitals included in the PPA project. The main outcome was the proportion of cesarean section. We used total cost of hospitalization for women and newborns, from the perspective of the health care provider, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of cesarean section and of maternal and neonatal complications.
Results: 238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the cesarean section probability (88.6% vs 31.7%, p <0.001) and an increase in the total cost of US$ 67,346.25, which an incremental cost-effectiveness ratio of US$ 1,183.59 per avoided cesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal nearmiss. The cost of uncomplicated vaginal births and cesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care.
Conclusion: The quality improvement project of childbirth care “PPA” was cost-effective in reducing cesarean sections in women assisted in a Brazilian private hospital, without increasing severe negative maternal and neonatal outcomes and reducing the frequency of early term births.
Keywords
cesarean delivery, healthcare quality improvement, hospitals medicine, Cost-effectiveness
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CURRENT STATUS: Under Review
Version 1
Posted 03 Sep, 2020
No community comments so far
Editorial decision: Minor revision
On 20 Feb, 2021
Reviewer #3 agreed
On 30 Jan, 2021
Reviewer #2 agreed
On 20 Oct, 2020
Review #2 received
Received 20 Oct, 2020
Review #1 received
Received 19 Oct, 2020
Reviewer #1 agreed
On 02 Oct, 2020
Editor assigned
On 04 Sep, 2020
Reviewers invited
Invitations sent on 04 Sep, 2020
Editor invited
On 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
First submitted
On 28 Aug, 2020
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Subject Areas
Sexual & Reproductive Medicine
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A new preprint design is coming!
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This preprint is under consideration at Reproductive Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Rosa Maria Soares Madeira Domingues
Fundacao Oswaldo Cruz
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5722-8127
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 03 Sep, 2020
No community comments so far
Editorial decision: Minor revision
On 20 Feb, 2021
Reviewer #3 agreed
On 30 Jan, 2021
Reviewer #2 agreed
On 20 Oct, 2020
Review #2 received
Received 20 Oct, 2020
Review #1 received
Received 19 Oct, 2020
Reviewer #1 agreed
On 02 Oct, 2020
Editor assigned
On 04 Sep, 2020
Reviewers invited
Invitations sent on 04 Sep, 2020
Editor invited
On 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
First submitted
On 28 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Sexual & Reproductive Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: In 2015, a quality improvement project of childbirth care called Adequate Birth Project (“Projeto Parto Adequado”- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce cesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital - the model following the recommendations of the PPA and the standard of care model - in reducing the proportion of cesarean sections.
Methods: We conducted a case study in one of the private hospitals included in the PPA project. The main outcome was the proportion of cesarean section. We used total cost of hospitalization for women and newborns, from the perspective of the health care provider, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of cesarean section and of maternal and neonatal complications.
Results: 238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the cesarean section probability (88.6% vs 31.7%, p <0.001) and an increase in the total cost of US$ 67,346.25, which an incremental cost-effectiveness ratio of US$ 1,183.59 per avoided cesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal nearmiss. The cost of uncomplicated vaginal births and cesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care.
Conclusion: The quality improvement project of childbirth care “PPA” was cost-effective in reducing cesarean sections in women assisted in a Brazilian private hospital, without increasing severe negative maternal and neonatal outcomes and reducing the frequency of early term births.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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