Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach
Ineke van den Berga,b,f,∗, Guido C. Kaandorpa, Johanna L. Boscha,b, Johannes J. Duvekotc, Lidia R. Arendsd, M.G. Myriam Huninka,b,e a Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands b Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands c Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands d Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands e Department of Health Policy and Management, Harvard School of Public Health, Boston, USAf Clinic for Complementary Medicine Rodenrijs, Berkel en Rodenrijs, The Netherlands
Available online 9 February 2010
Objectives: To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation.
Design: A decision tree was developed to predict the number of caesarean sections preventedby BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVAT was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results.
Main outcome measures:We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed.
Results: The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was D 451 (95% CI D 109, D 775; p = 0.005) using Moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management.