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Acta Obstet Gynecol Scand. 2014 Apr;93(4):374-81. doi: 10.1111/aogs.12329. Epub 2014 Jan 29.

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

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1
Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands.

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.

KEYWORDS:

Costs; PPROM; expectant management; induction; labor

PMID:
24392746
DOI:
10.1111/aogs.12329
[Indexed for MEDLINE]
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