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Résumé :
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There is an increasing interest of health economic evaluations as an outcome to assess and compare health effects and costs of interventions, treatments or medical devices, next to the clinical outcomes. In perinatal care, the number of empirical studies including health economic evaluations are growing. An example of such a study is the OptiBIRTH trial, a multi-centre cluster randomised controlled trial, conducted in Germany, Ireland and Italy, aimed to investigate the effects of a woman-centred intervention designed to increase vaginal birth after caesarean (VBAC) through enhanced women-centred care. This dissertation is written in the context of the OptiBIRTH trial and provides insights in the different aspects of health economic evaluations in perinatal care in an international context. To start, we addressed several methodological challenges for health economic evaluations in perinatal care. A framework was developed to improve the comparability of health economic evaluations of perinatal care in an international setting, and to lower barriers for perinatal healthcare professionals, researchers and policy makers in understanding and performing health economic evaluations in perinatal care. Secondly, we evaluated the three months postnatal Health Related Quality of Life and the associations with the preference for birth mode and the actual birth mode in women after one previous caesarean section. Furthermore, the health economic implications of VBAC were evaluated. First, a health economic evaluation was performed to assess the cost-effectiveness of attempting a VBAC versus an elective repeat caesarean section based on a hypothetical cohort in four EU countries. Secondly, ahealth economic evaluation of the OptiBIRTH intervention was performed
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