ArticleBJOG : an international journal of obstetrics and gynaecology2025
Intended Conservative Management Versus Caesarean Hysterectomy for Known or Suspected Placenta Accreta Spectrum: A Cost-Effectiveness Analysis.
Article in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Maternal and neonatal outcomes in placenta accreta spectrum: Influence of antenatal diagnosis and surgical strategy.Turkish journal of obstetrics and gynecology · 2026Article
- Long-term outcomes in women with placenta accreta spectrum treated by one-step conservative surgery -prospective cohort study.BMC pregnancy and childbirth · 2026Article
- Maternal and Clinical Outcomes of Placenta Accreta Spectrum: Insights from a Retrospective Study in Bahrain.Life (Basel, Switzerland) · 2025Article
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveWe examined the cost-effectiveness of conservative management (CM) compared to planned caesarean hysterectomy (CH) for placenta accreta spectrum (PAS).
designA cost-effectiveness analysis in a theoretical cohort of patients.
settingA decision analytic model. POPULATION: A theoretical cohort of 1000 pregnant patients with PAS greater than 20 weeks gestation.
methodsIn base case analysis, we assumed that between 20% and 40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a 1 year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalisation, intensive care unit (ICU) admission and death. An incremental cost-effectiveness ratio (ICER) of $50 000 per quality-adjusted life year (QALY) defined cost-effectiveness. Sensitivity analyses were performed.
main outcome measuresThe cost gained per life year and per QALY.
resultsFor base case estimates, CM was the cost-saving strategy with an ICER of $9330.51 USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI and five fewer deaths. CM resulted in 149 more admissions with length of stay > 5 days and 25 more ICU admissions. In probabilistic sensitivity analysis, CM was the cost-effective strategy in 71% of runs and the dominant strategy in 42% of runs.
conclusionsCM was the cost-effective strategy for the management of PAS in greater than 70% of iterations of our model. Modelling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.
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