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- Title
Comparing induction of labour with oral misoprostol or Foley catheter at term: cost-effectiveness analysis of a randomised controlled multi-centre non-inferiority trial.
- Authors
ten Eikelder, M. L. G.; van Baaren, G‐J; Oude Rengerink, K.; Jozwiak, M.; de Leeuw, J. W.; Kleiverda, G.; Evers, I.; de Boer, K.; Brons, J.; Bloemenkamp, K. W. M.; Mol, B. W.; Ten Eikelder, Mlg; van Baaren, G-J; Bloemenkamp, Kwm
- Abstract
<bold>Objective: </bold>To assess the costs of labour induction with oral misoprostol versus Foley catheter.<bold>Design: </bold>Economic evaluation alongside a randomised controlled trial.<bold>Setting: </bold>Obstetric departments of six tertiary and 23 secondary care hospitals in the Netherlands.<bold>Population: </bold>Women with a viable term singleton pregnancy in cephalic presentation, intact membranes, an unfavourable cervix (Bishop score <6) without a previous caesarean section, were randomised for labour induction with oral misoprostol (n = 924) or Foley catheter (n = 921).<bold>Methods: </bold>We performed economic analysis from a hospital perspective. We estimated direct medical costs associated with healthcare utilisation from randomisation until discharge. The robustness of our findings was evaluated in sensitivity analyses.<bold>Main Outcome Measures: </bold>Mean costs and differences were calculated per women induced with oral misoprostol or Foley catheter.<bold>Results: </bold>Mean costs per woman in the oral misoprostol group and Foley catheter group were €4470 versus €4158, respectively [mean difference €312, 95% confidence interval (CI) -€508 to €1063]. Multiple sensitivity analyses did not change these conclusions. However, if cervical ripening for low-risk pregnancies in the Foley catheter group was carried out in an outpatient setting, with admittance to labour ward only at start of active labour, the difference would be €4470 versus €3489, respectively (mean difference €981, 95% CI €225-1817).<bold>Conclusions: </bold>Oral misoprostol and Foley catheter generate comparable costs. Cervical ripening outside labour ward with a Foley catheter could potentially save almost €1000 per woman.<bold>Tweetable Abstract: </bold>Oral misoprostol or Foley catheter for induction of labour generates comparable costs.
- Subjects
NETHERLANDS; MISOPROSTOL; URINARY catheters; INDUCED labor (Obstetrics); COST effectiveness; HEALTH outcome assessment; OXYTOCICS; CATHETERIZATION; CERVIX uteri; COMPARATIVE studies; DELIVERY (Obstetrics); LABOR (Obstetrics); RESEARCH methodology; MEDICAL cooperation; ORAL drug administration; THIRD trimester of pregnancy; RESEARCH; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; THERAPEUTICS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2018, Vol 125, Issue 3, p375
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14706