Economic analysis comparing induction of labor and expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks (PPROMEXIL trial)

Sylvia M C Vijgen, David P van der Ham, Denise Bijlenga, Johannes J van Beek, Kitty W M Bloemenkamp, Anneke Kwee, Mariët Groenewout, Michael M Kars, Simone Kuppens, Gerald Mantel, Jan F M Molkenboer, Antonius L M Mulder, Jan G Nijhuis, Paula J M Pernet, Martina Porath, Mallory D Woiski, Martin J N Weinans, Wim J van Wijngaarden, Hajo I J Wildschut, Bertina AkerboomJ Marko Sikkema, Christine Willekes, Ben W J Mol, Brent C Opmeer,

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To compare the costs of induction of labor and expectant management in women with preterm prelabor rupture of membranes (PPROM).

DESIGN: Economic analysis based on a randomized clinical trial.

SETTING: Obstetric departments of eight academic and 52 non-academic hospitals in the Netherlands.

POPULATION: Women with PPROM near term who were not in labor 24 h after PPROM.

METHODS: A cost-minimization analysis was done from a health care provider perspective, using a bottom-up approach to estimate resource utilization, valued with unit-costs reflecting actual costs.

MAIN OUTCOME MEASURES: Primary health outcome was the incidence of neonatal sepsis. Direct medical costs were estimated from start of randomization to hospital discharge of mother and child.

RESULTS: Induction of labor did not significantly reduce the probability of neonatal sepsis [2.6% vs. 4.1%, relative risk 0.64 (95% confidence interval 0.25-1.6)]. Mean costs per woman were €8094 for induction and €7340 for expectant management (difference €754; 95% confidence interval -335 to 1802). This difference predominantly originated in the postpartum period, where the mean costs were €5669 for induction vs. €4801 for expectant management. Delivery costs were higher in women allocated to induction than in women allocated to expectant management (€1777 vs. €1153 per woman). Antepartum costs in the expectant management group were higher because of longer antepartum maternal stays in hospital.

CONCLUSIONS: In women with pregnancies complicated by PPROM near term, induction of labor does not reduce neonatal sepsis, whereas costs associated with this strategy are probably higher.

Original languageEnglish
Pages (from-to)374-81
Number of pages8
JournalActa Obstetricia et Gynecologica Scandinavica
Volume93
Issue number4
DOIs
Publication statusPublished - Apr 2014

Keywords

  • Adult
  • Analgesics
  • Cost Control
  • Cost Savings
  • Cost-Benefit Analysis
  • Critical Care
  • Delivery, Obstetric
  • Female
  • Fetal Membranes, Premature Rupture
  • Humans
  • Incidence
  • Infant, Newborn
  • Intensive Care, Neonatal
  • Labor, Induced
  • Length of Stay
  • Monitoring, Physiologic
  • Netherlands
  • Pregnancy
  • Pregnancy Trimester, Third
  • Sepsis
  • Watchful Waiting
  • Comparative Study
  • Journal Article
  • Research Support, Non-U.S. Gov't

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