ArticleValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
Lifetime cost-effectiveness of trial of labor after cesarean in the United States.
Article in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses.PharmacoEconomics · 2024Pooled it
- Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery: A Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2017Pooled it
- Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital - A retrospective cohort study.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Predicting vaginal birth after previous cesarean: Using machine-learning models and a population-based cohort in Sweden.Acta obstetricia et gynecologica Scandinavica · 2021Article
- Reasons for previous Cesarean deliveries impact a woman's independent decision of delivery mode and the success of trial of labor after Cesarean.BMC pregnancy and childbirth · 2020Observational
- Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries.BMC pregnancy and childbirth · 2018Article
- Prenatal care and socioeconomic status: effect on cesarean delivery.Health economics review · 2018Article
- Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage.Anesthesiology · 2018Article
- Oseltamivir Treatment for Children with Influenza-Like Illness in China: A Cost-Effectiveness Analysis.PloS one · 2016Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectiveTo estimate the cost-effectiveness of a trial of labor after one previous cesarean (TOLAC) when incorporating long-term events and outcomes.
methodsA Markov model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Women were selected from a prospective study to derive probability estimates for potential events through three subsequent pregnancies. Probabilities for cerebral palsy and stress urinary incontinence, cost data, and quality-adjusted life-years (QALYs) were obtained from the literature. The primary outcome was cost-effectiveness measured as the marginal cost per QALY gained, with a $50,000 threshold per QALY used to define cost-effectiveness.
resultsThe TOLAC strategy dominated the ERCD strategy at baseline, with $164.2 million saved and 500 QALYs gained per 100,000 women. The model was sensitive to six variables: the probability of uterine rupture and successful TOLAC among women with no prior vaginal delivery, the frequency of stress urinary incontinence, and the costs of failed TOLAC, successful TOLAC, and ERCD. When the probability of TOLAC success was at the base value, 67.2%, TOLAC was preferred if the probability of uterine rupture was 3.1% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 47.2% or more. Probabilistic sensitivity analysis confirmed the base-case analysis.
conclusionsUnder baseline circumstances, TOLAC is less expensive and more effective than an ERCD when considering long-term consequences when the likelihood of success is 47.2% or more.
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