IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0001369.html
   My bibliography  Save this article

Optimizing availability of obstetric surgical care in India: A cost-effectiveness analysis examining rates and access to Cesarean sections

Author

Listed:
  • Lina Roa
  • Luke Caddell
  • Namit Choksi
  • Shylaja Devi
  • Jordan Pyda
  • Adeline A Boatin
  • Mark Shrime

Abstract

The objective of this study is to assess the cost-effectiveness of three different strategies with different availabilities of cesarean sections (CS). The setting was rural and urban areas of India with varying rates of CS and access to comprehensive emergency obstetric care (CEmOC) for women of reproductive age in India. Three strategies with different access to CEmOC and CS rates were evaluated: (A) India’s national average (50.2% access, 17.2% CS rate), (B) rural areas (47.2% access, 12.8% CS rate) and(C) urban areas (55.7% access, 28.2% CS rate). We performed a first-order Monte Carlo simulation using a 1-year cycle time and 34-year time horizon. All inputs were derived from literature. A societal perspective was utilized with a willingness-to-pay threshold of $1,940. The outcome measures were costs and quality-adjusted life years were used to calculate the incremental cost-effectiveness ratio (ICER). Maternal and neonatal outcomes were calculated. Strategy C with the highest access to CEmOC despite the highest CS rate was cost-effective, with an ICER of 354.90. Two-way sensitivity analysis demonstrated this was driven by increased access to CEmOC. The highest CS rate strategy had the highest number of previa, accreta and ICU admissions. The strategy with the lowest access to CEmOC had the highest number of fistulae, uterine rupture, and stillbirths. In conclusion, morbidity and mortality result from lack of access to CEmOC and overuse of CS. While interventions are needed to address both, increasing access to surgical obstetric care drives cost-effectiveness and is paramount to optimize outcomes.

Suggested Citation

  • Lina Roa & Luke Caddell & Namit Choksi & Shylaja Devi & Jordan Pyda & Adeline A Boatin & Mark Shrime, 2022. "Optimizing availability of obstetric surgical care in India: A cost-effectiveness analysis examining rates and access to Cesarean sections," PLOS Global Public Health, Public Library of Science, vol. 2(12), pages 1-15, December.
    • Handle: RePEc:plo:pgph00:0001369
    DOI: 10.1371/journal.pgph.0001369
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001369
    Download Restriction: no
    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0001369&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pgph.0001369?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Blake C Alkire & Jeffrey R Vincent & Christy Turlington Burns & Ian S Metzler & Paul E Farmer & John G Meara, 2012. "Obstructed Labor and Caesarean Delivery: The Cost and Benefit of Surgical Intervention," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-10, April.
    2. Shearer, Elizabeth L., 1993. "Cesarean section: Medical benefits and costs," Social Science & Medicine, Elsevier, vol. 37(10), pages 1223-1231, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Grant, Darren, 2022. "The “Quiet Revolution” and the cesarean section in the United States," Economics & Human Biology, Elsevier, vol. 47(C).
    2. Graham Cookson & Ioannis Laliotis, 2018. "Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 675-689, April.
    3. Meera Kotagal & Kiran J Agarwal-Harding & Charles Mock & Robert Quansah & Carlos Arreola-Risa & John G Meara, 2014. "Health and Economic Benefits of Improved Injury Prevention and Trauma Care Worldwide," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-7, March.
    4. Susan L. Greco & Anna Belova & Jin Huang, 2016. "Benefits of Decreased Mortality Risk from Reductions in Primary Mobile Source Fine Particulate Matter: A Limited Data Approach for Urban Areas Worldwide," Risk Analysis, John Wiley & Sons, vol. 36(9), pages 1783-1802, September.
    5. Jensen, Vibeke Myrup & Wüst, Miriam, 2015. "Can Caesarean section improve child and maternal health? The case of breech babies," Journal of Health Economics, Elsevier, vol. 39(C), pages 289-302.
    6. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Fee equalization and appropriate health care," Economics & Human Biology, Elsevier, vol. 41(C).
    7. Schulkind, Lisa & Shapiro, Teny Maghakian, 2014. "What a difference a day makes: Quantifying the effects of birth timing manipulation on infant health," Journal of Health Economics, Elsevier, vol. 33(C), pages 139-158.
    8. Andrea M. Tilstra, 2018. "Estimating Educational Differences in Low-Risk Cesarean Section Delivery: A Multilevel Modeling Approach," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 37(1), pages 117-135, February.
    9. Sara Allin & Michael Baker & Maripier Isabelle & Mark Stabile, 2015. "Accounting for the Rise in C-sections: Evidence from Population Level Data," NBER Working Papers 21022, National Bureau of Economic Research, Inc.
    10. Khawaja, Marwan & Kabakian-Khasholian, Tamar & Jurdi, Rozzet, 2004. "Determinants of caesarean section in Egypt: evidence from the demographic and health survey," Health Policy, Elsevier, vol. 69(3), pages 273-281, September.
    11. Jing Zhang & Roger Raufer & Lingxuan Liu, 2020. "Solar Home Systems for Clean Cooking: A Cost–Health Benefit Analysis of Lower-Middle-Income Countries in Southeast Asia," Sustainability, MDPI, vol. 12(9), pages 1-14, May.
    12. David M Goodman & Rohit Ramaswamy & Marc Jeuland & Emmanuel K Srofenyoh & Cyril M Engmann & Adeyemi J Olufolabi & Medge D Owen, 2017. "The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-19, July.
    13. Kaitelidou, Daphne Ch. & Tsirona, Christina S. & Galanis, Petros A. & Siskou, Olga Ch. & Mladovsky, Philipa & Kouli, Eugenia G. & Prezerakos, Panagiotis E. & Theodorou, Mamas & Sourtzi, Panagiota A. &, 2013. "Informal payments for maternity health services in public hospitals in Greece," Health Policy, Elsevier, vol. 109(1), pages 23-30.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0001369. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.