Reducing medical costs by adopting external cephalic version in a single perinatal center in Japan

Abstract

Aim

The rising rate of cesarean is a global public health concern. In Japan, the rate rose to 29.3% in 2023. Non-cephalic fetuses are typically delivered via cesarean; however, the external cephalic version (ECV) has the potential to reduce perinatal complications and healthcare costs. This study aimed to evaluate the medical cost savings and effectiveness of ECV.

Methods

This retrospective cohort study was conducted at a single perinatal center in 2023. ECV was performed under combined spinal-epidural anesthesia (CSEA). The primary endpoint was cost savings from ECV from a societal perspective.

Results

During the study period, 1332 deliveries occurred, of which 61 cases involved patients with non-cephalic fetuses. Among these, 79% agreed to undergo the ECV trial, with a 93% success rate. The cost savings per successful ECV resulting in normal vaginal delivery versus one elective cesarean were 226 695 yen. Compared to assuming all patients had undergone cesarean, the total delivery cost savings for ECV were 6 947 452 yen/1000 deliveries. ECV adoption reduced the cesarean rate from 26.7% to 23.9%, without significant adverse perinatal outcomes.

Conclusion

ECV performed under CSEA demonstrated a reduction in the medical costs covered by health insurance along with a high success rate and a reduction in the cesarean rate. By increasing insurance reimbursements for ECV, facilities that introduce ECV may increase, which may reduce cesarean rates without increasing the burden of social costs in Japan.