Comparing induction of labour with oral misoprostol or Foley catheter at term: cost-effectiveness analysis of a randomised controlled multi-centre non-inferiority trial

M. L.G. ten Eikelder*, G. J. van Baaren, K. Oude Rengerink, M. Jozwiak, J. W. de Leeuw, G. Kleiverda, I. Evers, K. de Boer, J. Brons, K. W.M. Bloemenkamp, B. W. Mol

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Objective: To assess the costs of labour induction with oral misoprostol versus Foley catheter. Design: Economic evaluation alongside a randomised controlled trial. Setting: Obstetric departments of six tertiary and 23 secondary care hospitals in the Netherlands. Population: 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). Methods: 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. Main outcome measures: Mean costs and differences were calculated per women induced with oral misoprostol or Foley catheter. Results: 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). Conclusions: Oral misoprostol and Foley catheter generate comparable costs. Cervical ripening outside labour ward with a Foley catheter could potentially save almost €1000 per woman. Tweetable abstract: Oral misoprostol or Foley catheter for induction of labour generates comparable costs.

Original languageEnglish
Pages (from-to)375-383
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume125
Issue number3
Early online date8 Aug 2017
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Cost-effectiveness
  • Foley catheter
  • induction of labour
  • oral misoprostol

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