Systematic review of economic aspects of alternative modes of delivery

Objective To carry out a systematic review of the literature relating to ec onomic aspects of alternative modes of delivery. Methods A comprehensive literature search of the years 1990-1999 was conduc ted of electronic and nonelectronic sources using a tested search strategy. Papers considered to contain useful cost or resource use data were read in full and classified according to their relevance to the review and their m ethodological quality. Relevant cost and resource use data were converted t o pound sterling and inflated to 1998-1999 price levels. Results The literature search resulted in 975 papers, 49 of which met crite ria for the review. Thirty-two papers were from the USA where the organisat ion, structure and costs of health care are significantly different from th at of other industrialised countries. The aggregate costs of different mode s of delivery reported in these American studies were between four and five times higher than costs reported in other studies. The majority of include d studies were of poor quality. Data from the better quality studies demons trated that caesarean section costs a health service substantially more tha n other modes of delivery. The range of costs of an uncomplicated vaginal d elivery were pound 629-pound 1298 compared with pound 1238-pound 3551 for a caesarean section. However, papers have so far only considered short term health service costs. Conclusions Research is required to estimate the cost and resource use attr ibutable to alternative modes of delivery. Future research should investiga te the long term health service costs and the costs that arise outside the health service which are likely to vary according to mode of delivery.