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Published on: January 17, 2019
Intended Conservative Management Versus Caesarean Hysterectomy for Known or Suspected Placenta Accreta Spectrum: A
Jessica C Morgan1, Erika N Hripko1, Brett D Einerson2
1Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA.
Objective:
We examined the cost-effectiveness of conservative management (CM) compared to planned caesarean hysterectomy (CH) for placenta accreta spectrum (PAS).
Design:
A cost-effectiveness analysis in a theoretical cohort of patients.
Setting:
A decision analytic model.
Population:
A theoretical cohort of 1000 pregnant patients with PAS greater than 20 weeks gestation.
Methods:
In base case analysis, we assumed that between 20% and 40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a 1 year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalisation, intensive care unit (ICU) admission and death. An incremental cost-effectiveness ratio (ICER) of $50 000 per quality-adjusted life year (QALY) defined cost-effectiveness. Sensitivity analyses were performed.
Main Outcome Measures:
The cost gained per life year and per QALY.
Results:
For base case estimates, CM was the cost-saving strategy with an ICER of $9330.51 USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI and five fewer deaths. CM resulted in 149 more admissions with length of stay > 5 days and 25 more ICU admissions. In probabilistic sensitivity analysis, CM was the cost-effective strategy in 71% of runs and the dominant strategy in 42% of runs.
Conclusions:
CM was the cost-effective strategy for the management of PAS in greater than 70% of iterations of our model. Modelling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.
