METAANALYSIS 
CITATIONS 

BenefitCost Summary Statistics Per Participant  

Benefits to:  
Taxpayers  $0  Benefits minus costs  $62  
Participants  $9  Benefit to cost ratio  $1.78  
Others  $173  Chance the program will produce  
Indirect  ($40)  benefits greater than the costs  98 %  
Total benefits  $142  
Net program cost  ($80)  
Benefits minus cost  $62  
Detailed Monetary Benefit Estimates Per Participant  
Benefits from changes to:^{1}  Benefits to:  

Taxpayers  Participants  Others^{2}  Indirect^{3}  Total 

Health care associated with Cesarean sections  $0  $9  $173  $0  $182 
Adjustment for deadweight cost of program  $0  $0  $0  ($40)  ($40) 
Totals  $0  $9  $173  ($40)  $142 
Detailed Annual Cost Estimates Per Participant  
Annual cost  Year dollars  Summary  

Program costs  $76  2014  Present value of net program costs (in 2018 dollars)  ($80) 
Comparison costs  $0  2014  Cost range (+ or )  20 % 
Estimated Cumulative Net Benefits Over Time (NonDiscounted Dollars) 
The graph above illustrates the estimated cumulative net benefits perparticipant for the first fifty years beyond the initial investment in the program. We present these cash flows in nondiscounted dollars to simplify the “breakeven” 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. 
MetaAnalysis of Program Effects  
Outcomes measured  Treatment age  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  
ES  SE  Age  ES  SE  Age  ES  pvalue  
Cesarean sections^{}  26  2  82761  0.143  0.016  26  0.000  0.000  27  0.143  0.001 
Althabe, F., Belizán, J.M., Villar, J., Alexander, S., Bergel, E., Ramos, S., . . . Latin American Caesarean Section Study Group. (2004). Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial. The Lancet, 363(9425), 19341940.
Sloan, N.L., Pinto, E., Calle, A., Langer, A., Winikoff, B., & Fassihian, G. (2000). Reduction of the cesarean delivery rate in Ecuador. International Journal of Gynecology & Obstetrics, 69(3), 229236.