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Table 2 Changes in per-patient costs due to the intervention, by clinical categorya, b

From: A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis

Cost component BMLM (crude) BMLM (adjusted)
Coef. (ß) ($) Std. Err. ($) 95% CI ($) P value Coef. (ß) ($) Std. Err. ($) 95% CI ($) P valuec
All participants (N = 105,351 patients; 32 hospitals)
 Delivery (caesarean or vaginal)d −8.3 8.2 (−24.4 to 7.7) 0.310 −6.2 7.7 (−21.3 to 9.0) 0.424
 Maternal complicationse 19.9 30.0 (−38.9 to 78.8) 0.507 16.3 29.9 (−42.3 to 74.8) 0.586
 Neonatal complicationsf −196 33.8 (−262 to −130) <0.001 −190 33.3 (−255 to −125) <0.001
Low-risk group (N = 49,281 patients; 32 hospitals)
 Delivery (caesarean or vaginal)d −17.2 9.4 (−35.7 to 1.3) 0.069 −22.0 9.0 (−39.5 to −4.5) 0.014
 Maternal complicationse 22.0 38.4 (−53.2 to 97.2) 0.566 14.7 38.1 (−59.9 to 89.3) 0.700
 Neonatal complicationsf −215 42.0 (−297 to −133) <0.001 −219 41.8 (−301 to −137) <0.001
High-risk group (N = 56,070 patients; 32 hospitals)
 Delivery (caesarean or vaginal)d 17.6 12.2 (−6.3 to 41.6) 0.149 14.8 12.2 (−9.0 to 38.7) 0.223
 Maternal complicationse 17.6 45.3 (−71.2 to 106) 0.698 14.2 45.1 (−74.3 to 103) 0.753
 Neonatal complicationsf −136 51.2 (−237 to −36.0) 0.008 −126 50.0 (−224 to −27.6) 0.012
  1. BMLM bivariate multilevel linear model, CI confidence interval
  2. aModel coefficients (ß), standard errors, and 95% confidence intervals present costs given in 2013 Canadian dollars = (0.94 USD) [30]
  3. bTotal costs calculated using CIHI National Physician Database 2011–2012 physician fees for the Province of Quebec [13]
  4. cThe P value is the probability of observing a result at least as extreme as the z-statistic, for the null hypothesis that the difference in the rate changes in costs for the intervention group from baseline to post-intervention versus the control group from baseline to post-intervention does not differ from zero
  5. dDelivery costs include: caesarean delivery (primary or secondary, with or without induction, with or without uterine scar, pediatric or adult); vaginal delivery (with or without anaesthetic, with or without intervention, assisted or unassisted, pediatric or adult)
  6. eMaternal complication costs include: maternal death, hysterectomy, symptomatic uterine rupture, thromboembolic disease, internal organ injuries, perineal tear (grades 3–4), puerperal infection/sepsis, postpartum hospital stay ≥7 days, admission to intensive care unit, readmission to hospital after postpartum discharge, blood transfusion
  7. fNeonatal complication costs include: intrapartum/neonatal death, Apgar score (<4; 4–7), major and minor acidosis (pH <7; pH 7–7.1), major and minor trauma, intraventricular haemorrhage, seizure at less than 24 h, invasive and non-invasive mechanical ventilation, necrotizing enterocolitis, hypoxic-ischaemic encephalopathy, cardiopulmonary morbidity, neonatal infection/sepsis, blood transfusion