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Am J Perinatol 2023; 40(03): 290-296
DOI: 10.1055/s-0041-1727213
Original Article

Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis

Jenny Y. Mei 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Divya Mallampati
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Ilina D. Pluym
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Christina S. Han 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Yalda Afshar 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
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Abstract

Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR.

Study Design We conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY).

Results In the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis.

Conclusion Twin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources.

Key Points

  • Cost effectiveness of twin VDs in the LDR versus OR was assessed.

  • Twin VDs in the LDR are cost effective based on current neonatal outcome data.

  • Attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis.

Keywords

twin vaginal deliveries - cost-effectiveness analysis - labor and delivery room

Note

This study was presented in poster format at Society of Maternal-Fetal Medicine's Annual Meeting, February 3–8, 2020, Grapevine, TX.


Supplementary Material



Publikationsverlauf

Eingereicht: 29. August 2020

Angenommen: 02. März 2021

Artikel online veröffentlicht:
20. April 2021

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