The objective of this study is to evaluate whether omission of intrauterine cleaning increases intraoperative and postoperative complications among women who deliver via cesarean section.
OBJECTIVE: The optimal method for repair of third-degree perineal lacerations remains controversial. Both the end-to-end and overlap methods of repair have been shown to be equally effective. However, the economic merits of the end-to-end approach compared with the overlap approach are unknown. The aim of this study was to evaluate the cost-effectiveness of the end-to-end compared with the overlap method of repair based on the results of six randomized clinical trials. METHODS: We performed a Markov-based decision analytic model of two management strategies for perineal lacerations—the end-to-end approach and the overlap approach. Baseline model parameters were obtained from six randomized clinical trials. Data were extracted for costs and outcomes of treatment. Costs were discounted annually at 3%. Patients' outcomes were modeled and incremental cost-effectiveness ratios were calculated from a societal perspective. The robustness of the results was determined by univariate and probabilistic sensitivity analyses by examining scatter plots of incremental costs and effectiveness. TreeAge Pro 2013 was used for data analysis. RESULTS: In the base case, compared with the overlap method of repair, the end-to-end approach was associated with a lower incidence of flatus and fecal incontinence and had better efficacy, resulting in an incremental benefit of 34.31 quality-adjusted life-years (QALYs) and an incremental cost-effectiveness ratio of 47,872 per QALY gained. Univariate sensitivity analysis showed findings to be robust under most scenarios. Probabilistic sensitivity analysis showed that there is a 96% probability that repair with the end-to-end approach was associated with a cost per QALY of less than $50,000. In 92% of simulations, the end-to-end approach was cost-saving in comparison with the overlap method of repair. CONCLUSION: This decision analysis demonstrates that the end-to-end method of repair is likely a more cost-effective strategy in treating women with third-degree perineal lacerations. The findings of the sensitivity analysis suggest that the results are robust to input variables and modeling assumptions.
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