# Obstructed Labor and Caesarean Delivery: The Cost and Benefit of Surgical Intervention

 Title: Obstructed Labor and Caesarean Delivery: The Cost and Benefit of Surgical Intervention Author: Vincent, Jeffrey R.; Burns, Christy Turlington; Alkire, Blake Christian; Metzler, Ian Scott; Farmer, Paul Edward; Meara, John Gerard Note: Order does not necessarily reflect citation order of authors. Citation: Alkire, Blake C., Jeffrey R. Vincent, Christy Turlington Burns, Ian S. Metzler, Paul E. Farmer, and John G. Meara. 2012. Obstructed labor and caesarean delivery: The cost and benefit of surgical intervention. PLoS ONE 7(4): e34595. Full Text & Related Files: 3338803.pdf (250.7Kb; PDF) Abstract: Background: Although advances in the reduction of maternal mortality have been made, up to 273,000 women will die this year from obstetric etiologies. Obstructed labor (OL), most commonly treated with Caesarean delivery, has been identified as a major contributor to global maternal morbidity and mortality. We used economic and epidemiological modeling to estimate the cost per disability-adjusted life-year (DALY) averted and benefit-cost ratio of treating OL with Caesarean delivery for 49 countries identified as providing an insufficient number of Caesarean deliveries to meet demand. Methods and Findings Using publicly available data and explicit economic assumptions, we estimated that the cost per DALY (3,0,0) averted for providing Caesarean delivery for OL ranged widely, from $251 per DALY averted in Madagascar to$3,462 in Oman. The median cost per DALY averted was \$304. Benefit-cost ratios also varied, from 0.6 in Zimbabwe to 69.9 in Gabon. The median benefit-cost ratio calculated was 6.0. The main limitation of this study is an assumption that lack of surgical capacity is the main factor responsible for DALYs from OL. Conclusions: Using the World Health Organization's cost-effectiveness standards, investing in Caesarean delivery can be considered “highly cost-effective” for 48 of the 49 countries included in this study. Furthermore, in 46 of the 49 included countries, the benefit-cost ratio was greater than 1.0, implying that investment in Caesarean delivery is a viable economic proposition. While Caesarean delivery alone is not sufficient for combating OL, it is necessary, cost-effective by WHO standards, and ultimately economically favorable in the vast majority of countries included in this study. Published Version: doi:10.1371/journal.pone.0034595 Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338803/pdf/ Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:10364560 Downloads of this work: