Anesthesia in Breech Delivery May Cut Average Costs

Jenni Laidman

April 18, 2013

The additional expense of providing neuraxial anesthesia during the performance of external cephalic version (ECV) in breech fetal presentation may result in an overall cost savings because of the higher success rate for ECV under anesthesia and the decreased probability of cesarean delivery, according to results from a study published online April 16 in Anesthesia & Analgesia.

Brendan Carvalho, MBBCh, FRCA, from the Department of Anesthesiology, Stanford University School of Medicine, California, and colleagues conducted a cost analysis of anesthesia for a single ECV attempt, using a previously published computer simulation decision model. The ECV success probability was based on the results of 6 randomized controlled studies conducted from January 1980 to September 2010 that were identified in a systematic review of articles published in the Cochrane Library, EMBASE, Medline, and Web of Sciences.

The studies showed an average ECV success rate without anesthesia of 38% for a singleton infant delivered at term, with 96 of 255 cases successful. In the individual studies, success rates ranged from 31% to 58% without anesthesia. By comparison, the average success rate for ECV with anesthesia was 60% (151/253 patients) in those 6 studies, with success rates in individual studies ranging from 44% to 87%.

The model showed that neuraxial anesthesia for ECV reduced overall costs if anesthesia increased the absolute ECV success rate by 11% or more over the baseline.

Mean expected total delivery costs, including the cost of attempting ECV with anesthesia, were $8931 (2.5th to 97.5th percentile prediction interval, $8541 - $9252). Without ECV anesthesia, the mean cost was $9207 (2.5th to 97.5th percentile prediction interval, $8896 - $9419). The expected cost of neuraxial anesthesia was $134, including the cost of anesthesiologist time and equipment.

The expected mean incremental difference between delivery costs with and without anesthesia for ECV was −$276 (2.5th to 97.5th percentile prediction interval, −$720 to $112).

Study limitations included the model's failure to include factors such as quality of life, patient preference, and rare risks of neuraxial techniques. The grouping of all neuraxial techniques into a single studied intervention was a further limitation; no studies have compared the success rates of spinal, epidural, and combined spinal–epidural techniques. Success rates used in the model were not weighted by study quality.

This study was supported by the Stanford University School of Medicine Department of Anesthesia. The authors have disclosed no relevant financial relationships.

Anesth Analg. Published online April 16, 2013. Abstract