NICE Admits "Extra £800 Cost" Doesn't Add Up

A great deal is being made of maternal request cesareans (principle of choice aside) being a waste of tax-payers money and an unaffordable luxury in the current economic climate. 

But, and it's a BIG BUT, the reported estimated £800 extra cost is flawed.

Even NICE admits this in its 2011 Guideline Update (Draft), as indeed it did in its 2004 Guideline too (even though it was dismissed).

When both PLANNED modes of delivery (cesarean and vaginal) plus their subsequent intrapartum AND longer term health consequences are assessed, a "different cost-effectiveness result" could be produced, says NICE.
Here is an extract from the 2011 NICE Update Draft on the subject of Health Economics:

"However, there may be other outcomes, such as urinary incontinence, which were not reported in the studies that were included in the clinical review which make the findings reported above more uncertain. Sensitivity analysis suggested that this could, under certain assumptions, produce a different cost-effectiveness result.

An economic model developed for this guideline suggested that planned vaginal birth was cost- effective compared to a maternal request CS. However, this finding was limited to outcomes that were reported in the included studies for the clinical review undertaken for this guideline (see section 4.2). A sensitivity analysis suggested that the inclusion of adverse outcomes not reported, such as urinary incontinence, could make the cost-effectiveness conclusion less certain.

On balance this model does not provide strong evidence to refuse a woman’s request for CS on cost-effectiveness grounds."

Women are Willing to Pay

One last point on this subject.

Regardless of whether NICE's figures are correct or not, I've heard from numerous women in the UK who say they would be perfectly willing to pay £800 in order to plan a cesarean birth in the NHS - in order to avoid the stress of fighting for their birth choice, spending their entire pregnancy waiting to hear if their request will be granted, and being faced with a private hospital bill running into £1000s as their only other alternative.

(Bold highlighting above is mine)