Anesthesia reduces costs for external cephalic version

Total delivery costs are lower-and rates of vaginal delivery higher-when external cephalic version (ECV) is done with versus without neuraxial anesthesia. So say the results of a study by Stanford University researchers published online in Anesthesia & Analgesia.

The new research was based on national data on the cost of ECV with and without anesthesia and costs of vaginal and cesarean deliveries and from previous comparisons of ECV success rates with and without anesthesia. The investigators analyzed the data using a computer cost model, which considers possible outcomes and probability uncertainties at the same time.

Using anesthesia increased average success rates for ECV from 38% (individual study range 31% to 58%) to 60% (individual study range 44% to 87%). Because it led to fewer cesareans, anesthesia also decreased total delivery cost by an average of $276 (range $720 savings to $112 additional cost). Mean expected total delivery costs-including the cost of attempting/performing ECV with anesthesia-were $8,931 (range $8,541 to $9,252) versus $9,207 (range $8,896 to $9,419) without anesthesia.

The researchers concluded that increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV. The reason for the increased success rates ECV, said lead author Brendan Carvalho, MD, may be that muscle relaxation triggered by anesthesia allows practitioners to apply less pressure when performing the procedure.