|Benefit-Cost Summary Statistics Per Participant|
|Taxpayers||$0||Benefits minus costs||$236|
|Participants||$14||Benefit to cost ratio||$7.87|
|Others||$273||Chance the program will produce|
|Indirect||($17)||benefits greater than the costs||100 %|
|Net program cost||($34)|
|Benefits minus cost||$236|
|Detailed Monetary Benefit Estimates Per Participant|
|Benefits from changes to:1||Benefits to:|
|Health care associated with Cesarean sections||$0||$14||$273||$0||$288|
|Adjustment for deadweight cost of program||$0||$0||$0||($17)||($17)|
|Detailed Annual Cost Estimates Per Participant|
|Annual cost||Year dollars||Summary|
|Program costs||$34||2014||Present value of net program costs (in 2016 dollars)||($34)|
|Comparison costs||$0||2014||Cost range (+ or -)||20 %|
|Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)|
|The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.|
|Meta-Analysis of Program Effects|
|Outcomes measured||No. of effect sizes||Treatment N||Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis||Unadjusted effect size (random effects model)|
|First time ES is estimated||Second time ES is estimated|
Chaillet, N., Pasquier, J.-C., Dube, E., Fraser, W.D., Abrahamowicz, M., Dugas, M., Burne, R., et al. (2015). A cluster-randomized trial to reduce cesarean delivery rates in Quebec. New England Journal of Medicine, 372(18), 1710-1721.
Liang, W.H., Yuan, C.C., Hung, J.H., Yang, M.L., Yang, M.J., Chen, Y.J., & Yang, T.S. (2004). Effect of peer review and trial of labor on lowering cesarean section rates. Journal of the Chinese Medical Association : Jcma, 6(6), 281-6.
Main, E. K. (1999). Reducing cesarean birth rates with data-driven quality improvement activities. Pediatrics, 103(1), 374-83.
Myers, S.A., & Gleicher, N. (1993). The Mount Sinai cesarean section reduction program: an update after 6 years. Social Science & Medine, 3(10), 1219-22.
Poma, P.A. (1998). Effect of departmental policies on cesarean delivery rates: a community hospital experience. Obstetrics and Gynecology, 91(6), 1013-8.
Robson, M.S., Scudamore, I.W., & Walsh, S.M. (1996). Using the medical audit cycle to reduce cesarean section rates. American Journal of Obstetrics and Gynecology, 174(1), 199-205.
Sanchez-Ramos, L., Kaunitz, A.M., Peterson, H.B., Martinez-Schnell, B., & Thompson, R.J. (1990). Reducing cesarean sections at a teaching hospital. American Journal of Obstetrics and Gynecology, 163(3), 1081-7.