Budget impact of a program for safely reducing caesarean sections in Canada

Area of Science:

• Health Economics
• Obstetrics
• Public Health Policy

Background:

• Cesarean section (CS) rates and associated costs are a significant concern in healthcare.
• The QUARISMA study evaluated audits, feedback, and best practices to reduce CS rates.
• Previous findings indicated a small reduction in CS and cost savings in Quebec.

Purpose of the Study:

• To determine the budget impact of the QUARISMA program.
• To estimate the financial consequences of extending the QUARISMA program nationwide.
• To analyze the cost-effectiveness of implementing best practices in obstetrics.

Main Methods:

• A retrospective pre-post study design was used to analyze costs before and after QUARISMA implementation in Quebec (105,351 subjects).
• A prospective analysis estimated the budget impact across Canadian provinces over a 4-year horizon.
• Sensitivity analysis was performed by varying probabilities to assess the robustness of the findings.

Main Results:

• Over 4 years, Quebec experienced cost reductions of over $7.8 million in CS burden, $11.9 million in vaginal births, and $9.8 million for neonatal complications.
• The program demonstrated cost savings in Quebec totaling $27 million over 4 years.
• Initial implementation costs were incurred by provinces in the first two years.

Conclusions:

• The QUARISMA program achieved substantial cost savings in Quebec.
• Nationwide expansion of the QUARISMA program is projected to yield significant financial benefits, estimated at $150.5 million in the short to medium term.
• Implementing evidence-based practices through programs like QUARISMA can lead to considerable healthcare savings.