Estimating the Financial Impact of Reducing Primary Cesareans

Area of Science:

• Obstetrics and Gynecology
• Health Economics
• Maternal-Fetal Medicine

Background:

• Preventing primary cesarean births for nulliparous women with term, singleton, vertex (NTSV) pregnancies is crucial for reducing maternal and newborn risks.
• Professional organizations advocate for strategies to lower NTSV cesarean rates.
• The American College of Nurse-Midwives (ACNM) leads the Reducing Primary Cesareans (RPC) Learning Collaborative.

Purpose of the Study:

• To estimate the cost savings associated with a reduction in NTSV cesarean births.
• To analyze hospital costs for vaginal birth, primary cesarean, and repeat cesarean deliveries.

Main Methods:

• Utilized hospital data from October 1, 2016, to March 31, 2017 (N=1747).
• Calculated total hospital costs using resource consumption profiles for vaginal birth, primary cesarean, and repeat cesarean groups, including newborn care.
• Developed a model to estimate cost differences for first and subsequent births and overall savings.

Main Results:

• Primary cesarean births for NTSV pregnancies incurred $5989 more in costs compared to vaginal births.
• Repeat cesarean births incurred $4250 more compared to vaginal births.
• Preventing 69 primary cesareans in 2016 resulted in $413,241 savings; preventing 66 repeat cesareans projected an additional $280,500, totaling $693,741. Apgar scores and length of stay were unchanged.

Conclusions:

• Participation in the ACNM's RPC Learning Collaborative yielded substantial hospital cost savings within the first year.
• The cesarean reduction efforts did not negatively impact quality metrics such as Apgar scores or length of stay.
• The developed cost-comparison model is replicable for other hospitals aiming to reduce cesarean rates.