Budget impact of a program for safely reducing caesarean sections in Canada.

  • Date de publication : 2018-02-09


Bermúdez-Tamayo C, Johri M, Chaillet N. Budget impact of a program for safely reducing caesarean sections in Canada. Midwifery. 2018 May;60:20-26. doi: 10.1016/j.midw.2018.01.022. Epub 2018 Feb 9. PubMed PMID: 29477053.



audits of indications for cesarean section (CS), feedback for health professionals, and implementation of best practices, as compared with usual care (QUARISMA study), resulted in a small reduction in the rate of CS in Quebec and important cost savings from a health care payer perspective. Determining the budget impact would enable estimation of the financial consequences if the program is extended nationwide.


a retrospective pre-post study design was used to estimate cost prior to and after the implementation of QUARISMA in Quebec (105,351 subjects). A prospective analysis was performed to measure the budget impact in Canada's provinces. The primary analytic perspective was that of the Minister of Health, for a 4-year time horizon. Data were taken from the trial for Quebec and extrapolated to Canada's provinces. A sensitivity analysis was conducted by varying more than one probability at a time.


over 4 years, there was a decrease of more than $7.8 million in CS burden in Quebec, $11.9 million in vaginal birth and $9.8 million for neonatal complications. The impact on high-risk women was lower than that on low-risk. In years 1 and 2, the provinces would have to cover the cost of program implementation.


QUARISMA led to savings of $27 million in Quebec over 4 years. In the short to medium term, extending the QUARISMA program nationwide could lead to savings of $150.5 million.