{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T11:43:54Z","timestamp":1772451834457,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>We examined the cost\u2010effectiveness of conservative management (CM) compared to planned caesarean hysterectomy (CH) for placenta accreta spectrum (PAS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cost\u2010effectiveness analysis in a theoretical cohort of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A decision analytic model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A theoretical cohort of 1000 pregnant patients with PAS greater than 20\u2009weeks gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In base case analysis, we assumed that between 20% and 40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a 1\u2009year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalisation, intensive care unit (ICU) admission and death. An incremental cost\u2010effectiveness ratio (ICER) of $50\u2009000 per quality\u2010adjusted life year (QALY) defined cost\u2010effectiveness. Sensitivity analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The cost gained per life year and per QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For base case estimates, CM was the cost\u2010saving strategy with an ICER of $9330.51\u2009USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI and five fewer deaths. CM resulted in 149 more admissions with length of stay &gt;\u20095\u2009days and 25 more ICU admissions. In probabilistic sensitivity analysis, CM was the cost\u2010effective strategy in 71% of runs and the dominant strategy in 42% of runs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CM was the cost\u2010effective strategy for the management of PAS in greater than 70% of iterations of our model. Modelling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18025","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T06:00:33Z","timestamp":1733464833000},"page":"1096-1103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intended Conservative Management Versus Caesarean Hysterectomy for Known or Suspected Placenta Accreta Spectrum: A Cost\u2010Effectiveness Analysis"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9741-1866","authenticated-orcid":false,"given":"Jessica C.","family":"Morgan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Chicago  Chicago Illinois 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