Managing Uncomplicated Singleton Breech Pregnancy Using the OptiBreech Collaborative Care Pathway: Early Economic Model and Value of Information Analysis

• Published in: Value in health Vol. 28; no. 5; pp. 751 - 761
• Main Authors: Shetty, Siddesh S., Walker, Shawn, Fox-Rushby, Julia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2025
• Subjects: Breech Presentation - economics; Breech Presentation - therapy; Cost-Benefit Analysis; cost-effectiveness analysis; Decision Trees; early economic evaluation; Female; Humans; Internal Medicine; Models, Economic; OptiBreech collaborative care; Pregnancy; Public Health; vaginal breech birth; value of information analysis; vaginal breech birth; value of information analysis; early economic evaluation; cost-effectiveness analysis; OptiBreech collaborative care
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2025.01.013

Management of breech presentation is a subject of ongoing clinical debate. The cost-effectiveness of improving safe vaginal breech birth is unknown. This study examines potential cost-effectiveness of OptiBreech collaborative care and assesses value of undertaking further research. A decision tree was used to evaluate the potential cost-effectiveness of OptiBreech care versus standard care for a hypothetical cohort of women with confirmed singleton breech pregnancy after 36 + 0 weeks gestation and babies born thereafter for 1 year. Probabilities, costs, and outcomes were obtained from literature and OptiBreech pilot trial. Uncertainty and value of information were analyzed to prioritize future research. The main outcomes were incremental cost-utility and cost-effectiveness ratios, net benefits, cost-effectiveness acceptability curve, and expected value of perfect and perfect partial information. Using preexisting evidence, OptiBreech care is less effective but sufficiently less costly, ie, cost-effective compared with standard care. Influential parameters include cephalic birth rate after external cephalic version, training costs, and vaginal birth rate after opting for vaginal birth. Emerging evidence for OptiBreech care significantly improved the cost-effectiveness ratio. The expected population value of perfect information was £31.5 million, with utilities identified as key research priority. Planned vaginal birth for singleton breech pregnancy may be cost-effective despite a potential loss in health outcomes. Emerging data on the effectiveness of OptiBreech care significantly increased the cost-effectiveness likelihood. Conclusions did not change for litigation cost assumptions or for sole neonatal perspective. Further research on health utilities would provide a valuable reduction in decision uncertainty. •Early estimates using literature evidence suggest that OptiBreech collaborative care may be cost-effective despite potential health outcome trade-offs. This study illustrates both supportive and opposing scenarios and highlights the value of future research.•Alternative scenarios using emerging OptiBreech care evidence, accounting for litigation costs, or focusing solely on newborn costs and outcomes, show improved cost-effectiveness potential.•Substantive evaluation of the OptiBreech care bundle, particularly further research on health-related quality of life, can reduce decision-making uncertainty.