Cost-effectiveness of single-layer versus double-layer uterine closure during caesarean section on postmenstrual spotting: economic evaluation alongside a randomised controlled trial
In: BMJ Open, Jg. 11 (2021-07-01), Heft 7
Online
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Zugriff:
ObjectiveTo evaluate the cost-effectiveness of double-layer compared with single-layer uterine closure after a first caesarean section (CS) from a societal and healthcare perspective.DesignEconomic evaluation alongside a multicentre, double-blind, randomised controlled trial.Setting32 hospitals in the Netherlands, 2016–2018.Participants2292 women ≥18 years undergoing a first CS were randomly assigned (1:1). Exclusion criteria were: inability for counselling, previous uterine surgery, known menstrual disorder, placenta increta or percreta, pregnant with three or more fetuses. 1144 women were assigned to single-layer and 1148 to double-layer closure. We included 1620 women with a menstrual cycle in the main analysis.InterventionsSingle-layer unlocked uterine closure and double-layer unlocked uterine closure with the second layer imbricating the first.Main outcome measuresSpotting days, quality-adjusted life-years (QALYs), and societal costs at 9 months of follow-up. Missing data were imputed using multiple imputation.ResultsNo significant differences were found between single-layer versus double-layer closure in mean spotting days (1.44 and 1.39 days; mean difference (md) −0.056, 95% CI −0.374 to 0.263), QALYs (0.663 and 0.658; md −0.005, 95% CI −0.015 to 0.005), total healthcare costs (€744 and €727; md €−17, 95% CI −273 to 143), and total societal costs (€5689 and €5927; md €238, 95% CI −624 to 1108). The probability of the intervention being cost-effective at willingness-to-pay of €0, €10 000 and €20 000/QALY gained was 0.30, 0.27 and 0.25, respectively, (societal perspective), and 0.55, 0.41 and 0.32, respectively, (healthcare perspective).ConclusionDouble-layer uterine closure is not cost-effective compared with single-layer uterine closure from both perspectives. If this is confirmed by our long-term reproductive follow-up, we suggest to adjust uterine closure technique guidelines.Trial registration numberNTR5480/NL5380.
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Cost-effectiveness of single-layer versus double-layer uterine closure during caesarean section on postmenstrual spotting: economic evaluation alongside a randomised controlled trial
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Autor/in / Beteiligte Person: | Judith E Bosmans ; Daniela H Schippers ; Hermes, Wietske ; Sueters, Marieke ; Mireille N Bekker ; WM van Baal ; Janssen, CAH ; Scheepers, HCJ ; Stegwee, Sanne I. ; Ben, Ângela J. ; Mohamed El Alili ; Lucet F. van der Voet ; Christianne J.M. de Groot ; Bosmans, Judith E. ; Judith A.F. Huirne ; Erik van Beek ; Ângela Jornada Ben ; Karin de Boer ; Elisabeth MA Boormans ; Hugo WF van Eijndhoven ; Feitsma, AH ; Christianne JM de Groot ; Hemelaar, Majoie ; Wouter JK Hehenkamp ; Hink, Esther ; Judith AF Huirne ; Anjoke JM Huisjes ; Kapiteijn, Kitty ; Kaplan, Mesrure ; Paul JM van Kesteren ; Judith OEH van Laar ; Langenveld, Josje ; Wouter J Meijer ; Angèle LM Oei ; Dimitri NM Papatsonis ; Celine M Radder ; Robbert JP Rijnders ; Nico WE Schuitemaker ; Sanne I Stegwee ; Visser, Harry ; Huib AAM van Vliet ; LHM de Vleeschouwer ; Lucet F van der Voet ; Obstetrics and gynaecology ; Amsterdam Reproduction & Development (AR&D) ; APH - Quality of Care ; APH - Societal Participation & Health ; RS: GROW - R4 - Reproductive and Perinatal Medicine ; MUMC+: MA Medische Staf Obstetrie Gynaecologie (9) ; Obstetrie & Gynaecologie ; Health Economics and Health Technology Assessment ; Amsterdam Public Health ; APH - Mental Health ; APH - Methodology ; APH - Aging & Later Life |
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Zeitschrift: | BMJ Open, Jg. 11 (2021-07-01), Heft 7 |
Veröffentlichung: | BMJ Publishing Group, 2021 |
Medientyp: | unknown |
ISSN: | 2044-6055 (print) |
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