The analysis used a computer-based decision-tree model, with a 12-week time horizon. The authors stated that a societal perspective was adopted.
The clinical data were identified by a systematic review of the literature in MEDLINE, the Cochrane Library, and UpToDate, plus a manual search of references from the retrieved articles. Meta-analyses were selected; otherwise the mean probabilities were calculated from the available study data, adjusted by the study sample size. The rate of success with ECV was the key clinical input.
Monetary benefit and utility valuations:
The utility values were estimated using the European Quality of life (EQ-5D) questionnaire, in the general population.
Measure of benefit:
Quality-adjusted life-years (QALYs) were the summary benefit measure.
The economic analysis included the hospital costs for ECV, vaginal delivery, elective caesarean delivery, and emergency caesarean delivery, as well as the costs of obstetrician’s professional service and mother’s time. The cost of caesarean delivery included anaesthesiology. The complications of delivery were also included as additional hospitalisation costs. Medical costs were from hospital bills, at Medicare reimbursement rates, while the cost of the mother’s time was valued using the official median income for a full-time, year-round, female worker. The expected duration of procedure and length of stay were from the US Department of Health. All costs were in US dollars ($) and the price year was 2007. Future costs were discounted at an annual rate of 3%.
Analysis of uncertainty:
One- and multi-way sensitivity analyses were carried out by varying both the probabilities and the costs. The ranges of values were derived from the literature.