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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