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Related Experiment Video

Updated: Jun 16, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?
08:49

External Cephalic Version: Is it an Effective and Safe Procedure?

Published on: June 6, 2020

Cost-effectiveness of external cephalic version for term breech presentation.

Jonathan M Tan1, Alex Macario, Brendan Carvalho

  • 1Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, New York 11794-8480, USA. jonathan.tan@stonybrook.edu

BMC Pregnancy and Childbirth
|January 23, 2010
PubMed
Summary

External cephalic version (ECV) for breech presentation is cost-effective for society if the success rate exceeds 32%. This method offers better quality-adjusted life years (QALYs) compared to scheduled cesarean delivery when successful.

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Area of Science:

  • Obstetrics and Gynecology
  • Health Economics
  • Perinatal Medicine

Background:

  • External cephalic version (ECV) is recommended to convert breech presentation to vertex, reducing cesarean delivery rates.
  • The study aimed to assess the cost-effectiveness of ECV versus scheduled cesarean for term breech presentation from a societal perspective.

Purpose of the Study:

  • To determine the incremental cost-effectiveness ratio (ICER) of ECV compared to scheduled cesarean delivery for term breech presentation.
  • To evaluate the economic value of ECV based on health-related quality of life and actual hospital costs.

Main Methods:

  • A decision-analytic model was developed using TreeAge Pro software.
  • The model incorporated published literature probabilities for ECV success, spontaneous reversion, delivery mode, and emergency cesarean, alongside hospital costs and quality-adjusted life year (QALY) utilities.
  • The primary endpoint was the ICER in dollars per QALY gained, with a cost-effectiveness threshold of $50,000/QALY.

Main Results:

  • At a baseline ECV success rate of 58%, the ICER was $7,900/QALY.
  • ECV becomes more costly and yields poorer QALYs if the success rate falls below 32%.
  • ECV is cost-effective (ICER < $50,000/QALY) when the success probability is between 32% and 63%; it is less costly and offers better QALYs if success exceeds 63%. The model's sensitivity analysis highlighted success probability as the key factor.

Conclusions:

  • ECV is a cost-effective strategy for term breech presentation compared to scheduled cesarean, provided the success probability is greater than 32%.
  • Further research is needed to develop improved algorithms for predicting successful ECV outcomes.
  • Optimizing ECV success rates can enhance its value proposition in obstetric care.